Sleep Apnea

Overview

Obstructive sleep apnea, along with insomnia, is one of the most frequent nighttime disorders and it affects between 4 and 6% of the population. In fact, it’s estimated as many as 18 million Americans are suffering from sleep apnea.

Sleep Apnea Explained

Obstructive sleep apnea (OSA), also referred to as obstructive sleep apnea hypopnea (OSAH), is a disorder which causes a person to suddenly stop breathing while sleeping. Although OSA is caused by an obstruction in the upper airway system, there are many other factors which increase a person’s predisposition to it.

Snoring and apnea are usually not noticed by the patient themselves, but it results in restless sleep and is related to the onset of fatigue and drowsiness during the day.

Further to this, the lack of proper ventilation in the upper airway system is often associated with low oxygen levels in the blood which can aggravate or cause arterial hypertension, ischemic heart disease, cardiac arrhythmias or strokes.

New studies have also suggested sleep disorder is linked to small brain lesions and a symptomless form of stroke, known as silent stroke.

Symptoms

Sleep Apnea Symptoms

Usually the symptoms of obstructive sleep apnea appear gradually and worsen with age. The presence of fragmented sleep and low blood oxygen levels which occur during the distinct breathing stoppages (apnea) cause the following symptoms:

• Excessive sleepiness or daytime drowsiness
• Loud snoring which interrupts sleep, accompanied by shortness of breath and suffocation, caused by the lack of air during sleep
• Disrupted sleep – Nocturnal awakenings accompanied by body movements
• Lack of concentration and memory loss
• Morning headaches and irritability
• Chronic fatigue

Causes

Causes of Sleep Apnea

Although obstructive sleep apnea is caused by an obstruction in the upper airway system, there are other precipitating factors:

1. Obesity and being overweight are the main risk factors because the accumulation of fat around the pharynx makes it more collapsible
2. Old age and being male
3. Tobacco, alcohol and sedatives for their depressive action on the respiratory system
4. Postural factors, such as sleeping face up
5. Physical attributes such as a short neck or small jaw
6. Changes in the oropharynx, as presented by a large tongue (macroglossia), a soft descended palate, or having large and swollen tonsils
7. Metabolic alterations as presented by hypothyroidism, acromegaly, and metabolic syndrome

Risk Factors for Sleep Apnea

Early recognition and treatment of sleep apnea is important as it may be associated with:

1. Irregular heartbeat
2. High blood pressure
3. Heart attack
4. Stroke
5. Daytime sleepiness
6. Increased risk of motor vehicle accidents

Diagnosing & Treating

Diagnosing And Treating Sleep Apnea

A complete history and careful physical examination are paramount in assessing whether sleep apnea is present in a patient with snoring symptoms. The history and examination results also guide the clinician in deciding whether a nocturnal polysomnogram is necessary and in determining appropriate treatment.

The patient’s risk factors should be assessed, including male gender, increase in weight, ingestion of alcohol, allergies, nasal obstruction, trauma, use of muscle-relaxing medications and smoking. An assessment of daytime functioning including concentration levels, work performance, and sleepiness, should be documented. The Epworth Sleepiness Scale, (see below) which assesses the level of daytime sleepiness, has been used to distinguish primary snoring from obstructive sleep apnea–hypopnea syndrome.

Treatment

Non-Surgical

Oral appliances

Once a patient has been diagnosed with a OSAHS condition, oral appliance therapy (OAT) may be a non-surgical option for treatment. These appliances can be very effective for patients who suffer from snoring and mild to moderate sleep apnea. Oral appliances may also be recommended for the severe sleep apnea patients if they are unable to tolerate CPAP (continuous positive airway pressure). Although oral appliances have a similar appearance to mouth guards, they require specific design, fabrication and customized fitting to meet individual patient needs for proper forward re-positioning of the lower jaw and tongue to improve the opening of the upper airway during sleep for successful treatment results. These appliances require follow-up and monitoring. At ARID, together with our affiliated sleep centers, we use advanced technology and specialized equipment to measure the airway, predict improvement, and determine appliance design and monitor success and efficacy of the oral appliance.

Surgical

Upper Jaw Surgery

Upper jaw surgery, also known as upper jaw orthognathic surgery, maxillary advancement, or a LeFort 1 osteotomy, is a common procedure for patients who have trouble breathing, an underbite, or facial asymmetry. While upper jaw surgery can seem intimidating, the process is safe and patients report about as much discomfort as having their wisdom teeth removed, a small price to pay for a lifetime of better breathing, better chewing and higher confidence.

Lower Jaw Surgery

Lower Jaw Surgery, also known as mandibular surgery, or a bilateral sagittal split ramus osteotomy (BSSRO), is a safe, effective procedure for patients with sleep apnea, overbite, or facial asymmetry. Like upper jaw surgery, lower jaw orthognathic surgery is an effective treatment that can help you achieve better health, an attractive smile and better bite for the rest of your life.

Orthognathic Surgery Recovery

The recovery process for jaw surgery usually involves a modified diet and one to three weeks off work or school. Numbness will occur after surgery, but sensation usually returns, and the numbness helps avoid discomfort during orthognathic surgery recovery. Discomfort can also be managed through medication, and jaws are almost never wired shut. Patients are usually prescribed a liquid diet for the first six weeks after surgery, and then a soft, no-chew diet for another six weeks.  After the twelve weeks you will be able to eat anything you want, and chew better than ever before.