Sleep Apnea

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. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.

In addition to a detailed history, Dr. Kreps, Dr. Roccia, Dr. Tunder, Dr. Marsh or Dr. Singh will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes an Otolaryngologist (Ear, Nose and Throat doctor) will perform a naso-pharyngeal exam 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 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 by an Ear, Nose and Throat (ENT) surgeon 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.

Often times, the base of the tongue can be moved forward, thus decreasing obstruction. This can be accomplished by a procedure that repositions the chin and related tongue muscles forward, known as a genioglosseal advancement. This procedure is performed by Drs. Kreps, Roccia, Tunder, Marsh or Singh under general anesthesia in the hospital. A genioglosseal advancement can be performed as an isolated surgery or in combination with other surgical options.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day hospital stay.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment. Drs. Kreps, Roccia, Tunder, Marsh or Singh will discuss in detail your specific cause of obstructive sleep apnea at the time of consultation.