People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.
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.
Sleep Apnea Treatment
The first step in treatment for sleep apnea resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.
In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. 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 may be recommended to monitor an individual overnight.
Treatment Options for Sleep Apnea
There are several treatment options available. An 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 office.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
Inspire Therapy for Sleep Apnea Inspire therapy is a breakthrough implantable treatment option for people with Obstructive Sleep Apnea who are unable to use or get consistent benefit from CPAP. While you are sleeping, Inspire monitors every breath you take. Based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.
Inspire therapy is controlled by a small handheld sleep remote. The remote allows you to turn Inspire therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.
The Inspire system is made of a small battery and 2 small wires. Inspire is placed under the skin of the neck and chest through three small incisions during an outpatient procedure. Most patients return home the same day and return to non-strenuous activities within a few days.
- 78% reduction in sleep apnea events per hour
- 88% reduction in bed partner reported snoring
- 97% reduction in bed partners leaving room due to snoring
Inspire therapy is indicated for patients with the following characteristics:
- 22 years of age or older
- Have moderate to severe OSA (AHI range from 15-65 with <25% central apneas)
- Unable to use CPAP
- Free of complete concentric collapse at the palate
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.