What is obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is a condition whereby the upper airway is obstructed during sleep and causes temporary suspension of breathing or reduction of airflow. There are various reasons for the obstruction of the upper airway, which include excess tissues or fats in the back of the throat, large tonsils, large tongue, mispositioning of the jaws, and narrowed nasal passages.
The symptoms of OSA are snoring, excessive daytime sleepiness, choking or gasping air during sleep, disturbed sleep, high blood pressure, poor mental function etc. The sleep obstruction causes disturbed sleep as the apnoea will trigger an impulse to wake the sleeping patient to restart the breathing process.
Oral and maxillofacial surgeons will be able to perform a physical examination and screen for signs and symptoms of OSA. A sleep study conducted in a hospital setting will often be required to diagnose and assess the severity of the OSA.
Why should I seek treatment?
Patients with OSA often have excessive daytime sleepiness, and they may not be able to function well in their daily activities and work, resulting in reduced work productivity and impaired quality of life. The sleepy patients could also be prone to traffic accidents when they operate vehicles.
If left untreated, patients with OSA may be at risk of developing medical problems such as high blood pressure, heart attack, stroke, irregular heart rhythm and other heart diseases. Hence, OSA is a serious and potentially life-threatening condition which requires attention and treatment.
What are the treatment options?
The treatment options for OSA depend on the diagnosis, cause of the obstruction and the severity of the condition. The options include lifestyle and behavioural modification, continuous positive airway pressure therapy (CPAP), oral appliances, and surgeries or a combination. Patients with OSA are often managed together by a team of sleep physicians and surgeons.
Weight loss is recommended for obese or overweight patients with OSA. Some patients may also benefit from changing their sleeping position to prevent sleeping on their back which can relieve OSA symptoms.
Most patients with OSA often start with CPAP therapy. This involves a machine which delivers pressurized oxygen through a nasal mask to prop up the airway during sleep.
Oral appliances, such as mandibular advancement devices, are splints which can be worn by the patients to move the lower jaw and/or tongue forward to reduce airway constriction.
Surgeries may be performed for the soft tissues such as nasal surgeries, tonsillectomy, uvulopalatopharyngoplasty or hard tissues such as maxillomandibular advancement and genioglossus advancement. These treatments may be performed in stages or in combination.
Maxillomandibular advancement (jaws advancement) may be indicated for patients with mispositioned jaws or severe OSA, which are recalcitrant to other treatments. Maxillomandibular advancement is a surgery whereby the upper and lower jawbones are repositioned forward to increase the size of the upper airway.
Discuss with your surgeon to decide which treatment is best for you.
What to expect after treatment?
Patients will be reviewed regularly while undergoing treatment for OSA. A sleep study may be repeated to evaluate the results and progress of the treatment.