Obstructive Sleep Apnea (OSA)

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What Is OSA?

Obstructive sleep apnea (OSA) is a serious and even life-threatening condition. Most cases of undiagnosed OSA could result in morbidities such as heart attack, stroke, irregular heartbeat, high blood pressure, heart disease, and decreased libido. The National Sleep Foundation estimates that 18 to 20 million adults have obstructive sleep apnea and it is likely that OSA also affects 2% to 3% of children.

Diagnosis: Most patients with OSA are not aware of the pathology they experience. Patients find that their spouse or family member notices their loud snoring, periods of gasping for air or absolute lack of breathing during sleep.

During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.

The cessation of breathing or “apnea,”  initiates impulses from the brain to wake the person just enough to restart the breathing process. The gold standard method of diagnosing OSA is the polysomnography study or sleep study performed at sleep centers by sleep specialists.

How Do You Treat OSA?

CPAP is generally recommended as the initial managing device in patients with OSA and requires titration and follow-up for proper setting of the device. A certain number of patients are not tolerant of CPAP/BIPAP devices and seek an absolute surgical treatment for their OSA. Surgery may be a good alternative for some patients, but it’s important to keep in mind that no surgical procedure is universally successful. Uvulopalatopharyngoplasty (UPPP) has been advocated for in the past as a treatment in the management of OSA. This procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.

The UPPP procedure is known to be less than 30% effective and has severe postoperative discomfort and morbidity.

Dental/anterior positioning devices have been successful when used in a group of patients. It should be known, however, that these devices will not alleviate the obstruction at the level of the soft palate, which accounts for a large group of OSA patients.

On a routine basis, Dr. Movahed reviews the patient’s airway in a comprehensive fashion. His study of the airway includes the three-dimensional mapping of the airway and pinpointing the most vulnerable site of obstruction. Additionally, a study of the nasal airway is performed in order to assess the status of the septum in case of any deviation or turbinates in case of hypertrophy (enlargement). An in-office pharyngoscopy procedure is also performed while the patient is awake in order to assess the tone and stiffness of the pharyngeal soft tissue. Based on the findings that are shared with our patients, the proper surgical modality is proposed and reviewed.

Surgery: Maxillomandibular Advancement (MMA) – This procedure surgically moves the upper and lower jaws forward along with the soft tissues of the tongue and palate, opening the upper airway. As a well studied and published surgical modality with a success rate of over 95%, this procedure will resolve the patient’s OSA, or at least decrease the Apnea-Hypopnea Index to or below 8.

Counterclockwise rotation (CCW) – Dr. Movahed performs his MMA surgery with a CCW rotation/movement which will result in an increased airway space in comparison to straight advancement. This surgical modality will also allow the patient to achieve a better aesthetic result. In order to achieve a stable result with MMA/CCW, Dr. Movahed performs a comprehensive evaluation of the temporomandibular joints and jaw skeleton.

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Obstructive Sleep Apnea

A solution to serious and life-threatening conditions.

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