People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. 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. It is the single major cause of hypertension. It also aggravates GERD, diabetes, cardiac arrythmias, increases risk of stroke 3X. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration. Some with ADHD are improved with OSA treatment. Chronic OSA causes brain atrophy and reduction of higher brain function. OSA is a very harmful and can shorten a person’s life unless it is treated.
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 resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.
In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
There are several treatment options available. An initial treatment may consist of using a CPAP machine that delivers pressurized air through a mask to keep the airway open at night. Another option is the use of an oral appliance that positions the lower jaw forwards to open the airway.
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. These are old and poorly effective treatments.
In many cases, the upper and lower jaws are repositioned forward (orthognathic surgery) to open the airway. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. This treatment is the single most effective, lasting treatment for OSA.
OSA is a very serious condition that needs careful attention and treatment. OHIP covers the hospital portion of this treatment.