Obstructive sleep apnea has been written about and highlighted by many authors in recent years.
This is for good reason. Obstructive sleep apnea (OSA) is a severe disease that affects many individuals in our community. If left untreated, sleep apnea can lead to numerous other disorders such as hypertension, irregular heartbeat, changes in mental abilities, strokes, diabetes, and premature death.
Obstructive sleep apnea is a complex disorder that has multiple causes and can present with different levels of severity. Because of this, there are multiple individuals involved in diagnosing and treating obstructive sleep apnea. Essentially, OSA is a condition that leads to the cessation of breathing usually caused by some sort of obstruction in the airway. Structures that lead to obstruction can be in the upper airway, such as nasal obstruction or elongated soft palate.
More frequently, obstructions are in the lower airway caused by the tongue moving posterior, obstructing the airway. The lateral walls of the airway can collapse contributing to this obstruction. There are other unusual causes related to the central nervous system. One of the most common measurements of the severity of sleep apnea is the Apnea-Hypopnea Index (AHI). Mild AHI is 5-15 events per hour, moderate is 15-30 events per hour, and severe is greater than 30.
Proper diagnosis should be performed using a sleep study coordinated with a certified sleep physician. Once a diagnosis of OSA is made, then a team of physicians and dentists steps in to assist with various treatment modalities. Certain treatments are directed toward controlling the disease. Others may lessen or even cure OSA. Individuals typically involved in treating OSA are sleep physicians, general dentists, otolaryngologists, neurologists, and oral maxillofacial surgeons.
Treatment modalities that control OSA are CPAP and dental repositioning splints. CPAP (full mask with positive pressure) is by far the most successful at controlling OSA. Jaw repositioning splints provided by a dentist can be successful in mild-to-moderate sleep apnea.
Modalities that help decrease the severity or may even cure OSA are weight loss, nasal and/or septal surgery, UPPP (surgery on the soft palate and throat), or jaw repositioning surgery.
Nasal surgery or UPPP is usually provided by an otolaryngologist and helps address obstruction involving the area of the upper airway. These are successful in 30-35% of patients. For the remaining patients, the obstruction is either of a central cause or involves the lower or lateral airways.
Jaw repositioning surgery is provided by oral maxillofacial surgeons. This treatment is geared to alter not only the upper airway but also the lower airway. This can also indirectly improve the lateral wall support. Jaw repositioning surgery moves the upper and lower jaws forward. This, in turn, pulls the soft tissue of the palate and tongue forward, opening up the upper and lower airways. This soft tissue movement can also tighten the lateral walls of the airway, reducing their tendency to collapse. The larger the movement of the upper and lower jaws, the higher probability of successful treatment of OSA.
This surgery is performed in a hospital setting with use of general anesthesia. The patient is usually able to recover and resume normal activity and diet within about 6 weeks. These surgeries are indicated in patients who have difficulty tolerating CPAP or already have pre-existing jaw disorders which can be improved by jaw surgery.
There are different combinations of jaw surgery. Sometimes it may involve only the maxilla or upper jaw. Other times it may involve only the mandible or lower jaw. These may also include advancement of the chin. The success increases with the number of jaws included in the advancement and the amount that each is moved. Complications can include temporary or permanent numbness of areas of the face, alteration in appearance, dysfunction of the temporomandibular joint, changes in bite, or some relapse of the facial bones.
A recent study showed OSA was reduced from AHI of 117.9 to 16.1 with jaw surgery.1 A meta-analysis study, which reviewed all known legitimate articles on OSA, found that jaw advancement was a viable alternative to help decrease or cure OSA.2
Jaw surgery does take a commitment of time and requires a surgical procedure, but it is certainly a viable option for treatment of obstructive sleep apnea patients. If you have questions, please contact an oral maxillofacial surgeon treating these conditions.