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Neal A. Zabiegalski, Oral Surgery

(301) 862-5600

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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.  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 soft tissues and skeletal anatomic relationships in the maxillofacial region. With cephalometic (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 is recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a breathing machine that delivers continuous positive airway pressure (CPAP) oxygen through a nasal mask to limit obstruction at night. In mild to moderate cases a snore guard appliance can be fabricated and is less cumbersome then CPAP.   One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed on the back of the soft palate to remove excess flappy tissue called the uvula.   In cases of macroglossia (very large tongue) another surgical option is tongue reduction. These types of procedures are done in an ambulatory center or a “23 hour” hospital stay.

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 overnight stay in the hospital.
Treatment is guided using a team approach with your physician, dentist, otolaryngologists and oral surgeon involved.