Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep patterns 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, individuals with obstructive sleep apnea 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.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Dr. Fraser offers consultation and treatment options.

In addition to a detailed history, Bruce A. Fraser, DDS, MS will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, Dr. Fraser 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 at the sleep center.

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 airway obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the soft palate and back of the 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 using procedural IV sedation in the outpatient surgical suite.

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 at the medical center in the operating room under general anesthesia and requires a 1 or 2 day hospital admission.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.

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