What is Sleep Apnoea?
Apnoea is defined as a temporary absence or cessation of breathing. The most common cause of sleep apnoea in adults is obstructive sleep apnoea / hypopnoea syndrome (OSAHS). OSAHS is a condition in which a person experiences repeated episodes of apnoea because of a narrowing or closure of the pharyngeal airway during sleep. The essence of this is that for various reasons, there is not enough space in the upper part of the airway (the mouth, nose and throat) to allow adequate flow of air to the lungs for normal breathing.
Who is at risk for Sleep Apnoea?
Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia - small/pushed back jaws), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. Obstructive sleep apnoea has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS. (The excerpt is from NICE guidelines issued in March 2008).
How does Jaw Surgery address Obstructive Sleep Apnoea?
Many cases of obstructive sleep apnoea can be treated with jaw surgery. In very simple terms, by surgically moving the jaws to create more space in the upper airway, air can better be delivered to the lungs. There is an increasing body of evidence that demonstrates the effectiveness of orthognathic jaw surgery as a very useful modality in our ability to treat this condition. The advantage of this surgery is that it can do away with noisy CPAP (continuous positive airway pressure) machines or uncomfortable and cumbersome dental splints holding the jaws in a particular posture throughout the night for years. For details as to the care pathway for orthognathic surgery see the jaw surgery link.
Why should we seek to treat this condition?
Sleep apnoea is very destructive to people's physical health, relationships with partners and overall quality of life. It results in daytime sleepiness which in turn affects an increase in road traffic accidents, how one thinks, one's mood, and therefore one's outlook on daily living. OSAHS is associated with high blood pressure, an increase in the risk of cardiovascular disease and stroke.
How does one decide what treatment is best?
The decision as to what is the optimal treatment should take into consideration the patients' needs / preferences and the input of a multi-disciplinary team of GPs, respiratory physicians, dentists, orthodontists, otolaryngologists and maxillofacial surgeons who have an interest in this condition. Patients need to be assessed by this team to determine the best treatment for their specific case. This will range from medical intervention with weight loss, exercise, continuous positive airway pressure (CPAP), various jaw splints and surgery to the jaws, mouth or throat.
NICE (National Institute for Clinical Excellence) published recommendations for the treatment of OSAHS with Continuous Positive Airway Pressure (CPAP) in March 2008. Please note these are guidelines only for CPAP and its place in the treatment of obstructive sleep apnoea. The following are excerpts from this publication:
"Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea / hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and / or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep."
The NICE guidelines go on to say that the efficacy of dental devices has been established in clinical trials and that these devices are traditionally viewed as a treatment option for mild and moderate OSAHS.
The NICE guidelines also state that there is a lack of evidence to support the effectiveness of surgery involving the resection of the uvula and redundant retrolingual soft tissue (not to be confused with the effectiveness of this treatment for snoring).