Obstructive Sleep Apnea and Snoring

Are you falling asleep driving or sitting in the movie theater? Are you irritable, lack energy at work, job performance is depleted, and you feel somewhat depressed? You may be suffering from sleep apnea. People with Obstructive Sleep Apnea (OSA) have disrupted sleep and low blood oxygen levels.

Obstructive sleep apnea (OSA) is a serious medical condition in which the tongue and soft tissues in the back of the throat collapse and block the airway, preventing air from getting to the lungs. This blocking reduces the oxygen supply to the brain, which then sends a signal to respiratory muscles to tighten to unlock the passage of air. Stages of sleep are violently disturbed during these moments where airflow stops. The severity of snoring varies with the level of sleep apnea.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, loss of concentration, diabetes, high blood pressure, obesity, and the development of an enlarged neck.

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 being referred to a physician specializing in sleep disorders to have a consultation and treatment.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With various types of imaging (cephalometric – skull, MRI, CT) and sleep study tests, doctors can understand the level and structure of obstructions. 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 (polysomnography) may be recommended to monitor an individual overnight.

There are several treatment options available. Initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser-assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the physician’s office.

For some patients who have mild apnea diagnosed by a sleep study, you can benefit from an oral appliance that provides an improved jaw position to address snoring and mild sleep apnea.

OSA is a very serious condition that needs careful attention and treatment.
Mandibular advancement appliances (MAD) work by re-aligning the lower jaw and tongue to keep the airway open. It is a non-surgical approach. They are comfortable, easy to maintain, and non-invasive. The American Academy of Sleep Medicine recommends these devices in cases of snoring (without OSA) or mild OSA, and patients with OSA moderate and severe who are intolerant to or refuse CPAP.

Dr. Lam-Do is one of only six dentists in Quebec who holds a mastership from the American Academy of Dental Sleep Medicine.

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