Obstructive Sleep Apnea and Oral Surgery

The airway is the pathway that air travels between the outside world and our lungs. It is helpful to think if the airway conceptually as a long drinking straw. The two factors that affect air flow the most are the length of the straw and the diameter of the straw. Intuitively, this makes sense; the longer and more narrow your straw, the more suction force you need to apply in order to drink. The same principles apply to the airway when we inspire air: the longer and narrower our airway, the more force we need to apply in order to get the air into our lungs. 

In general, men have longer airways than women, simply because, on average, they are taller and have a longer airway anatomically. And in fact men are more likely to develop OSA than women are.

But who is susceptible to having a narrower airway? There are two scenarios for this:

1. Excess adipose tissue: when patients gain weight, they develop fat deposits throughout the body, and the tongue is no exception. Fatty deposits in the tongue lead to its encroachment on the airway, since the tongue is the posterior border of airway. So weight gain leads to airway narrowing, which in turn predisposes to the development of OSA (narrower straw).

2. Anatomically small jaws: Even thin patients can develop OSA, if they have anatomically small jaws. Since the airway is bordered by the jaws, smaller jaws means a smaller diameter airway.

Now, when patients are lying down and sleeping, the tone is gone from all of the muscles surrounding the airway (mostly the tongue, but the other surrounding tissues as well). This adds one more problem to the picture- this makes the airway COLLAPSIBLE in this area. So, when the patient is sleeping, and uses more force to get the air in, at a certain threshold force of inspiration, the airway collapses on itself, and hence we have obstruction of the airway. This obstruction leads to actual absence of air flow, which then wakes the patient up from their sleep. This can happen multiple times per hour, and the more frequently it happens, the more severe the OSA. The constant waking up means that the patient suffering from OSA never reaches the deepest levels of restorative sleep.

Therefore, the symptoms of OSA are: constant tiredness during the day, tendency to fall asleep easily during the day, never feeling rested, even when given the opportunity to sleep, and, many times, absence of dreams, because the patients don’t reach the deep levels of sleep necessary for dreaming. If untreated, significant OSA can lead to more sinister health problems, such as lung and cardiac disease.

There are many levels of treatment for OSA. The most conservative treatment is weight loss, although most patients are too tired from lack of sleep to really implement an effective diet and exercise program. Other conservative treatments are oral appliances, which position the lower jaw further forward, in an effort to increase the airway diameter. The problem with this is that all night long, patients have to sleep with their jaw in an uncomfortable position, and this can lead to other TMJ  issues. A great treatment option is CPAP, however, it can be uncomfortable to wear, and many patients do not tolerate it. 

There are several surgical treatment options for OSA. Some of them address the soft tissues, however these procedures are less predictable, because surgery on the soft tissues has a tendency to cause scar tissue, which can have a counter-productive effect on the airway. The most successful and most predictable surgery to treat obstructive sleep apnea is orthognathic surgery, or reconstructive jaw surgery. This surgery advances the jaws forward, physically expanding the anatomy. Patients notice the difference immediately after surgery. They feel more awake and alive than they can ever remember. 

Obviously, this surgery, like any surgery, has risks, so the decision to have surgery must be the conclusion of a careful risk-benefit analysis. But when the surgery is warranted, it has life-changing and life-saving benefits. 

If you have severe obstructive sleep apnea, and conservative treatments are not working for you, come in for a consultation to see if we can help you change your life.