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Sleep Apnea & Snoring

Obstructive Sleep Apnea Syndrome (OSAS) and Snoring

Obstructive Sleep Apnea Syndrome (OSAS) is a serious medical condition in which the flow of air is blocked in the upper airway—the nose, mouth or throat—enough to cause a decrease in oxygen to the heart and brain. Snoring without OSAS is known as Upper Airway Resistance Syndrome (UARS) and causes no significant physiologic or medical problems. OSAS is a medical condition which causes a decrease in breathing during sleep. This leads to inadequate oxygenation and can lead to problems with major organs such as the brain and heart. In OSAS, snoring usually follows a crescendo(increasingly loud) pattern until the patient stops breathing and then finally gasps for air. People OSAS have disrupted sleep and low blood oxygen levels. When OSAS occurs, the upper airway collapses and air flow stops. When the oxygen level in the brain becomes low enough, the individual partially awakens, the obstruction clears and the flow of air starts again, usually by gasping for breath.

Other symptoms of OSAS include obesity, excessive daytime somnolence or tiredness, loss of concentration, and headaches. The diagnosis to differentiate OSAS from simple snoring requires a sleep study called a polysomnogram in which breathing patterns, sleep patterns, and heart beat are measured during sleep. Initial therapy for OSAS is the use of a positive pressure breathing machine at night called a CPAP or bi-PAP. Patients with severe sleep apnea or those who can not tolerate the CPAP may be candidates for surgical correction.

Prior to having a procedure for sleep apnea or snoring, some documentation including an evaluation and a sleep study needs to be preformed to evaluate the level of oxygenation during sleep. The source of simple snoring or OSAS can originate from any region in the upper airway; such as the nose, soft palate, tongue or throat. As an Oral and Maxillofacial Surgeon, Dr. Tye is uniquely trained and qualified to evaluate and treat both snoring and sleep apnea. In addition to a detailed history, Dr. Tye will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, Dr. Tye can determine the area and level of obstruction.

Snoring and Mild OSAS Treatment

Those with simple snoring without apnea or those with mild apnea may benefit from less invasive procedures such as a Laser Assisted Uvuloplataplasty (LAUP) or the new Pillar® Procedure. For the LAUP, the soft palate is trimmed with a laser to minimize snoring. This is an office based procedure. Patients can return to work immediately afterwards; however one should expect a severe sore throat for 7-10 days. The Pillar® procedure involves inserting three small woven inserts into the soft palate to help stiffen it and reduce the vibration that causes snoring. This also is an office based procedure. The decision to perform the Pillar® or the LAUP depends upon one’s anatomy and sleep disturbance.

Moderate to Severe OSAS Treatment

There are several treatment options available for moderate to severe OSAS. An initial treatment may consist of sleeping with a nasal CPAP or bi-PAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. Procedures preformed for moderate to severe OSAS depend on the region of obstruction.

One of the surgical options is a uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. Additionally, nasal obstruction may contribute to OSAS and/or snoring. Nasal Surgery ( i.e., Septoplasty and Turbinectomy) can often improve breathing and sleep symptoms. Another surgical procedure to improve the airway is to move the base of the tongue forward. This is known as a Genial Tubercle Advancement. An advancement of the chin button where the tongue inserts is moved forward. This procedure is very successful in improving airway dynamics. In more complex cases, the bones of the upper and lower jaw may be repositioned forward to increase the size of the airway (Orthognathic –Jaw- surgery) with a maxillomandibular advancement. This procedure is done in the hospital under general anesthesia and requires 1 to 2 days overnight stay in the hospital.

OSAS is a very serious condition that needs careful attention and treatment. Most major medical insurance plans offer coverage for diagnosis and treatment of this disorder.

Obstructive Sleep Apnea Links

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