Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a widespread condition that is diagnosed in more people every day.  People may be unaware of having this condition, and symptoms may be present for years without identification of the underlying problem.  It is caused by obstruction of the upper airway during sleep that results in decreased blood oxygen saturation and frequent awakenings.  Long term effects of OSA can include cardiovascular disease, diabetes, weight gain and depression.  The cardiovascular risks are hypertension, pulmonary hypertension, congestive heart failure known as cor pulmonale, heart attack and stroke.  For these reasons, it is imperative not to ignore OSA and to try to manage it successfully.

OSA is diagnosed with polysomnography, or a sleep study.  This is most commonly ordered by a primary care physician, but can be ordered by any doctor.  There are many measurements that are recorded that help determine how often your breathing is reduced and stopped during sleep, as well as how many arousals from sleep there are per hour.  Please read the questions below to see if you should be considered for a sleep study.

There are both surgical and nonsurgical ways to manage OSA.  The first line of treatment is typically a CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure) machine that is worn at night.  These machines have proven to be a successful treatment strategy, however, their major pitfall is compliance.  That is because these machines are relatively bulky, noisy and uncomfortable.  Dental appliances may be beneficial in some, but not all cases.  This depends on where the obstruction occurs and how severe it is.  Also, not everyone tolerates these and most people will have to wear them the rest of their life.

For these reasons, many people explore surgical options.  There are many different surgeries that muddy the waters and become confusing.  Evidence shows that the only surgery that has proven to be definitively effective in treating OSA is maxillomandibular advancement.  This is a type of corrective jaw surgery where the upper and lower jaw are advanced forward, pulling the soft tissues of the airway forward as well and opening up the airway.  Please see the Corrective Jaw Surgery section for details on this procedure.

Are you at high risk for OSA?  Take the STOP BANG Questionnaire

If you answer yes to three or more of the following questions, you should speak to a doctor about obtaining a sleep study to evaluate for sleep apnea.

  • Snoring:  Do you snore loudly?
  • Tired:  Do you often feel tired or fatigued during daytime?
  • Observed:  Has anyone ever observed you stop breathing or gasping for air during sleep?
  • Pressure:  Are you being treated for elevated blood pressure?
  • BMI:  Is your BMI over 35?
  • Age:  Are you over 50 years old?
  • Neck:  Is the circumference of your neck over 17in or 40cm?
  • Gender:  Are you a male?