People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the soft palate and / or 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.
The first step in treatment for sleep apnea resides in recognition of the symptoms and seeking appropriate consultation with a sleep specialist. To determine the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study (Polysomnogram – PSG) is recommended to establish a diagnosis.
If referred to Dr. Fantuzzo for a surgical opinion, he will performa a detailed history and assess the anatomic relationships in the maxillofacial region. With clinical examination and cephalometic (skull x-ray) analysis, it is often possible to ascertain the level of obstruction. Sometimes evaluation by an Otorhinolaryngologist [Ear, Nose, and Throat Surgeon (ENT)] for a naso-pharyngeal exam is done with a flexible fiber-optic camera. These specialists may also perform a sleep endoscopy to determine the level of obstruction and recommend site specific treatment options.
There are several treatment options available and recommendations should be made in conjunction with a sleep specialist. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. 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 are usually by the Otorhinolaryngologist.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery -Maxillary, mandibular and chin advancement surgery) with or without septoplasty and reduction of the inferior turbinates. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment. Following nonsurgical and / or surgical treatment, an attended Polysomnogram (PSG) should be performed to evaluate effectiveness of therapeutic intervention.