Austin Oral Surgery answers your questions about sleep apnea.
What is sleep apnea?
While snoring results from the incomplete obstruction of the airway during sleep, complete obstruction produces cessation of breathing, or apnea. This is commonly referred to as obstructive sleep apnea syndrome, or OSAS. Obstruction is most commonly a result of relaxation of the muscles that support the throat, palate and tongue base. This relaxation produces narrowing or obstruction of the airway, especially when breathing in. As a result of this lack of breathing, the body’s oxygen levels drop and the brain arouses you to allow breathing to resume. Sleep is disrupted and deep, restful sleep is typically difficult because of the constant partial awakening. The consequences go beyond fragmented sleep, as the low oxygen levels over time may produce serious cardiac, vascular and metabolic changes. Symptoms include excessive daytime sleepiness, difficulty with concentration, irritability and morning headaches.
Who is at risk for sleep apnea?
Risk factors include both anatomic issues and behavioral factors. Obesity greatly increases the risk for apnea, and neck circumference alone (a thicker neck) is highly correlated with obstructive apnea. Smoking and the use of alcohol or sedative medications are risk factors as well. Smoking causes inflammation and swelling in the throat and triples the risk of apnea. Sedatives or alcohol consumption may cause excessive relaxation of the muscles of the throat, which worsens airway obstruction.
What are the medical consequences of sleep apnea?
The long-term exposure to low oxygen levels during sleep substantially increases the risk of high blood pressure (hypertension) and stresses the cardiovascular system. The risk of heart attack and stroke is greatly increased and cardiac-rhythm abnormalities, such as atrial fibrillation, are common. Metabolic issues such as insulin resistance, Type 2 diabetes and metabolic syndrome are often consequences of untreated apnea. Abnormalities in liver function and scarring (nonalcoholic liver disease) are sometimes observed as well. In addition, there are the issues produced by the lack of adequate sleep and sleep quality. These include excessive fatigue, moodiness, irritability, difficulty concentrating and, of course, sleep-deprived partners.
How is obstructive sleep apnea diagnosed and treated?
While the presence of these symptoms may be highly suggestive of OSAS, the diagnosis is established by analyzing the sleep quality with a sleep study. There are portable monitors that can be used overnight at home that may be useful screening exams and are fairly accurate in cases of severe disease. The gold standard, however, is a monitored overnight sleep study in a sleep lab. Once the results have been interpreted, the diagnosis can be made with a high degree of accuracy. If OSAS is present, the initial recommendation is nearly always a device that is worn at night during sleep. A CPAP, or continuous positive airway pressure, machine administers constant low-pressure airflow via a mask worn over the nose. This airflow helps open the obstructed airway and allows for normal breathing at night. While this is effective for almost everyone, many have difficulty tolerating the device at night. In these cases, surgery may be recommended or an oral device that temporarily repositions the jaw can be used.
What is the role of surgery in treatment?
For patients who cannot tolerate the CPAP device and for whom an oral appliance is not adequate, a procedure may be recommended. There are numerous procedures involving a laser or other devices to reshape the tongue base or palate, many of which are more appropriate for treating snoring. In some patients with specific obstruction in the palate or large tonsils, tonsil removal or palatal surgery may be the best choice, however the cure rates for most patients may not be adequate. Oral surgeons developed procedures to adjust the position of the jaw many years ago and for decades, these were used for the correction of bite problems. About 30 years ago, these procedures were adapted to treat sleep apnea. Most studies confirm cure rates in the 95 percent range, making orthognathic surgery, or jaw surgery, the most successful procedure if surgery is necessary. The three- to four-hour procedure is performed in the hospital, and after an overnight stay, most patients return home the next day. Most patients can expect to return to work in 10 to 14 days. If you are contemplating surgery, most surgeons will want sleep-study data and a trial of CPAP to occur first. Most medical insurance plans cover OSAS surgery.
For a consultation with Austin Oral Surgery, call 512.591.9557 or visit austinoralsurgery.com.