Treatment of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repeated lapses in breathing during sleep. These pauses, called apneic events, are caused by obstruction of airflow due to collapse of the upper airway, or via improper signals from the brain in the case of central sleep apnea. Symptoms of OSA include daytime drowsiness, snoring with pauses in breathing, gasping or choking during sleep and restless sleep. OSA can lead to high blood pressure, impotence, heart disease and other health problems.

Oral and maxillofacial surgeons (OMSs) are trained to help identify and recommend treatment options for patients with OSA. Several treatment options for OSA exist, and your OMS can help you decide which is right for you based on the severity of your OSA. Treatment options include:

Simple lifestyle adjustments such as weight loss or a change in sleeping position.
Oral appliances that bring the jaw forward during sleep.
Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) devices.
Surgical options.
Hypoglossal nerve stimulators.

Oral Appliance Therapy for OSA

An OMS may recommend oral appliance therapy if you have mild to moderate sleep apnea or are unable to tolerate CPAP or BiPAP. Oral appliances – similar in design to mouthguards and retainers – can be custom-made by your OMS to keep your airway open while you sleep. These devices are designed to reposition the lower jaw and bring the tongue forward to prevent it from falling into the airway and blocking breathing.

CPAP and BiPAP Therapy for OSA

CPAP is usually the first treatment option for patients with moderate to severe sleep apnea. A CPAP machine provides a constant, prescribed flow of pressured air through a specially fitted mask, which prevents the airway or throat from collapsing. BiPAP is similar to CPAP but has two different pressure settings for inhalation and exhalation.

CPAP and BiPAP devices can only treat the symptoms of OSA – they do not cure the condition itself. While these devices are generally effective and often the first treatment option tried by many patients, not every patient can tolerate their use.

Obstructive Sleep Apnea Surgery

In some cases, your OMS may recommend surgery to address the underlying cause of OSA. Surgical intervention is usually considered for moderate to severe sleep apnea when other treatment options have been ineffective or poorly tolerated.

Common surgical options performed by an OMS include:

Uvulopalatopharyngoplasty (UPPP): UPPP can be helpful for patients whose airways collapse at the back of the roof of the mouth (soft palate). By partially removing the uvula and reducing the edge of the soft palate, this procedure minimizes the excess tissue that can obstruct the airway.
Maxillomandibular advancement (MMA): During MMA surgery, the upper and lower jaws are repositioned to expand the airway and prevent the tongue and other soft tissues from blocking the airway during sleep.
Hyoid suspension: Hyoid suspension can be a good option for OSA patients whose collapse occurs at the base of the tongue. This procedure secures the hyoid bone – a U-shaped bone in the neck located above the Adam’s apple – to either the thyroid cartilage in the neck or the lower jaw to help stabilize the tongue base.
Genioglossus advancement (GGA): GGA opens the upper breathing passage by pulling forward and tightening the muscles under the tongue, so the tongue does not fall back into the airway and block breathing. Usually, this procedure is performed in conjunction with another procedure, such as an UPPP or hyoid suspension.
Hypoglossal nerve stimulators: Hypoglossal nerve stimulation utilizes an implanted medical device to stimulate a nerve under the tongue to prevent it from obstructing the airway during sleep.

Collaborative Approach

OMSs often work with other medical professionals – such as sleep medicine specialists, otolaryngologists (ENTs), pulmonologists and general dentists – to provide comprehensive care for patients with sleep apnea. A multidisciplinary approach can help to ensure the patient’s specific needs are addressed.

Seeking Treatment for Sleep Apnea

If you suspect you have or have been diagnosed with obstructive sleep apnea, contact an OMS. To diagnose OSA, an OMS may conduct a head and neck exam, interview your bed partner and refer you for a sleep study. They can develop a treatment plan specific to your needs and coordinate care with other providers if necessary.