Obstructive Sleep Apnea (OSA) is caused by an anatomical obstruction during sleep to the normal flow of air from the upper aerodigestive tract to the lungs. It may be secondary to actual anatomical deficiencies anywhere from the nose, soft pallet or base of tongue, or to the abnormal loss of compliance of the soft tissues of the upper airway secondary to weight gain, age or airway. It is exacerbated by excessive weight, advancing age, and certain anatomical variations to the neck and throat, the presence of tonsils and adenoidal tissue, among other factors.
The interruption of airflow causes a disruption of the REM cycle of sleep, or that portion of sleep, which is necessary for normal restoration of neurological function. The cessation of breathing results in a reduction in oxygenation of the blood and multiple episodes of awakening, up to 70 to 100 events per hour in the more severe cases. The normal individual experiences less than five such episodes per hour. Five to 15 episodes is termed mild OSA, and 15 and greater is moderate to severe. The metabolic consequences of these frequent disruptions are numerous and individuals from this disorder may experience an array of medical problems directly attributable to their OSA.
Common afflictions in this group include depression, hypertension, cardiovascular disease, stroke, diabetes, obesity, short-term memory deficits, cancer, and a predisposition to accidents of all types. Ten to 15 percent of all motor vehicle accidents are attributed to sleepiness and this disorder exceeds alcohol in the etiology of motor vehicle fatalities.
This disease was largely unrecognized as recently as 25 years ago and today it is poorly represented in the curriculum of most medical schools. As recognition has increased, it has become apparent through many studies that OSA represents a major public health and safety risk by not only the medical profession but by government regulatory agencies, most notably the National Transportation and Safety Board. The Federal Motor Carriers Association has identified OSA as a major risk factor for commercial truck drivers and is expected to mandate testing for all commercially licensed drivers in the near future. It is estimated that 2.4 to 3.9 million truck drivers alone suffer from significant OSA. This is an increasingly recognized public safety issue for all commercial transportation operators including airline pilots, bus drivers, taxi drivers, and heavy equipment operators to name a few. Studies have consistently found that untreated OSA patients are up to seven times more likely to be involved in an accident.
OSA secondary daytime impairment or OSA syndrome, is estimated to occur in one of every 20 adults and affects over 20 million individuals. Minimally symptomatic, OSA is estimated to occur in one of every five adults. Many of these individuals with advancing age and weight gain will progress to OSA syndrome during their lifetime. These statistics remain a problem likely to result in a large population level of morbidity.
The associated cost to our healthcare and legal systems of untreated OSA is staggering. OSA is an increasing problem for younger, active individuals who mostly rely on effective treatment to function at a work and social environment requiring hyper-vigilance and mental acuity not to mention the physically active attributes of this population. These individuals typically pursue treatment on an elective basis before medical problems become manifest.
Most patients are diagnosed by means of two inpatient overnight sleep tests, which quantify the severity of the disease process. The most commonly prescribed treatment is CPAP (Continuous Positive Airway Pressure), which remains the most common. The individual must wear a mask not unlike a breathing mask utilized in anesthesia, which is connected to the body, which generates positive pressure airflow through the mask thus distending the airway. The device is noisy. The mask has a tendency to become dislodged and many patients feel that CPAP treatment is more of an impediment to sleep than their disease. Travel with the device raises another set of problems, as is the disturbance of sleep of the individual’s sleep partner.
The side effects of CPAP include chronic dry mouth, sinusitis, recurrent ear infections, nasal obstruction, facial and corneal abrasions, sore throats, and orthopedic movement of the teeth to name a few. Due to many of the above factors, compliance with CPAP utilization is at best 35 percent and a majority of those who are actually compliant would welcome the opportunity to have a curative procedure.
At the Surgical Arts Centre, we have developed an outpatient treatment model for surgical correction of OSA. This involves advancement of both upper and lower jaws and is termed Maxillomandibular Advancement (MMA). The operation requires a general anesthetic and an extended overnight recovery. Patients are evaluated 24 hours postoperatively and are discharged home the first postoperative day. Most patients are able to return to work or school in 7 to 10 days and are prescribed a soft chewing diet within this same timeframe. Our delivery model has received international recognition and has been evaluated, published and presented in lectures to healthcare professionals. For those patients who suffer from significant sleep apnea and desire an option to CPAP, Maxillomandibular Advancement may represent a solution. If you or a family member is interested, please contact The Surgical Arts Centre for an evaluation regarding your disorder.
Questions and or comments regarding this week’s health column please contact Clark O. Taylor, M.D., D.D.S. at the Surgical Arts Centre, 1201 Westwood Drive, Suite A, Hamilton, MT 59840. Working together to build a healthier community!