Procedures

Sleep Apnea

People with obstructive sleep apnea (OSA) suffer from disrupted sleep and low blood oxygen levels that can lead to serious cardiac and other consequences including death. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms. To appropriately diagnose OSA a sleep study should be ordered to monitor an individual overnight. Only by sleep study can the amount of cardiovascular compromise and decreased oxygenation levels be confirmed.

After diagnosis of OSA is confirmed, Oral and maxillofacial surgeons, otolaryngologists (ENT) and sleep medicine specialists offer surgical and non-surgical treatment options. In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis and sometimes a naso-pharyngeal exam with a flexible fiber-optic camera, the doctors can ascertain the level of obstruction. Initially, non-invasive treatment methods may be considered. Even your dentist can often offer non-invasive treatment options that may improve less severe cases.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. If non-invasive methods such as CPAP or jaw positioning devices fail, then surgical methods can be considered. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to open and increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. Dr. Bonniwell is well trained in orthognathic surgery and performs these surgeries.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.