Obstructive Sleep Apnea(OSA)

Obstructive sleep apnea (OSA) affects millions of people, and there is a steep increase in cases over the last few decades.

What is Obstructive Sleep Apnea(OSA)?

Obstructive sleep apnea (OSA) is a condition in which a person's breathing stops involuntarily for short intervals of time during sleep. In a healthy person, air flows smoothly from the mouth and nose into the lungs. In persons with OSA, the normal flow of air is repeatedly stopped throughout the night due to the narrowed airway space in the area of the throat. Characteristic sign of OSA is snoring. During sleep the tongue, throat muscles and the lower jaw are relaxed. The lower jaw and the tongue fall backwards hitting the small tongue(uvula) creating a snoring sound. This results in decreased oxygen to the brain and other parts of the body. So the heart pumps more forcefully leading to enlargement of heart and cardiac arrest in later stages.  Carbon dioxide levels increase in the body. The brain senses this and sends signals to the tongue to move forward. The lower jaw also moves forward and leads to clenching or grinding of teeth eventually affecting the temporomandibular joints.

 Untreated sleep apnea can cause serious health problems such as:

• High blood pressure 
• Heart disease
• Stroke
• Weak immune system
• Diabetes            

Causes of OSA

• Overweight and obesity
• larger neck size
• Large tongue and/or smaller jaw bone
• Nasal obstruction due to deviated septum, allergies or sinus problem.
• Tonsillitis
• Long uvula 

Symptoms of OSA

• Snoring
• Day time drowsiness
• Lack of clarity in the morning
• feeling tired after sleep 
• awakening with dry mouth
• morning headache
• poor performance in everyday activity 
• Swelling in legs (in severe OSA cases)

Day time drowsiness is a cause of worry as it increases the risk of motor accidents and industrial accidents.

Diagnosis of Obstructive Sleep Apnea ( Sleep Apnea Test )

• Detailed case history taking
• STOP BANG questionnaire
• Clinical examination
  • Intra oral and extraoral examination
  • Examination of the nose and throat  for any extra tissue growth  or abnormalities
  • Measurement of the neck and waist circumference
  • Postural examination
  • Intra oral and extra oral photos
• Radiology
  • Full mouth x-ray (OPG)
  • Lateral Cephalogram to check for patency of airway
  • TMJ view (open and close, right and left)
  • Airway CBCT 3D Volumetry
  • MRI scan
  • Whole body scan
• Sleep study (HST –Home Sleep test or PSG – Polysomnograph)
• The diagnosis is made through different levels of overnight  monitoring of respiratory, sleep and cardiac parameters(polisomnography), aimed to detect the obstructive events and the following changes in blood oxygen saturation.

Treatment for OSA

Most often OSA is treated by a team of specialists including a neuromuscular orthodontist, physiotherapist, yoga and breathing specialist, ENT, Pulmonologist and a psychologist.

Conservative  treatment

•  Loosing weight 
• Avoiding alcohol consumption
• Avoid usage of sedatives
• Using a wedge pillow to sleep in a side position as sleeping on the back causes interruption in breathing repeatedly .
• Sinus problems or nasal congestion related problems can be treated with nasal sprays 

Oral appliances

Oral appliances are used to treat mild and moderate OSA patients and also  for patients with severe apnea who are unable to use nasal CPAP. 

Oral appliances help to maintain an open airway by bringing the lower jaw forward to provide enough space for the tongue.  These help in preventing the tongue from falling back and blocking the throat. It is worn just like a sports mouthguard. Its quite comfortable and easy to wear.

Orthodontic correction 

Fixed Appliance (Braces)  for maxillary and mandibular arch expansion.

PAP(positive air pressure) therapy : 

The most commonly used treatment , where the patient wears a mask and/or over the nose and mouth, an air blower gently forces air sufficient enough to prevent the collapse of the upper airway tissues through the nose/or the mouth.

Expiratory Positive Airway Pressure (EPAP)

Disposable adhesive valves are placed over the nose when the patient sleeps. During inhalation, the valve opens and helps to keep the airway open. During exhalation, the airflow is directed into small channels, which creates pressure to open the airway. 

Surgery

This is recommended only for people who have excessive tissue that obstructs airflow through nose or throat.

• Tonsillectomy -: uses radiofrequency energy to reduce the soft tissue causing the obstruction 
• Maxillary and mandibular advancement surgery
• Nasal surgery -  for correction of deviated septum that causes nasal obstruction .