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?
A common misconception unfortunately especially amongst many doctors is that one has to have a retruded lower jaw for a patient to benefit from Orthognathic surgery either as a single jaw procedure or as a bimaxillary advancement, sometimes also with a genioplasty. This is absolutely incorrect and outdated thinking, which condemns patients to lifelong CPAP treatment in many cases from our own personal experience over many years, unnecessarily. The most profound changes and relief in OSA come from advances in the upper jaw, even in some cases where the lower jaw isn’t advanced. Patients with normal profiles and normal appearing faces benefit just as much by these surgical interventions as patients with so called retruded facial profiles.
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?
Mr Heliotis has treated many patients with life changing results who were previously condemned to a CPAP machine with its accompanying problems both physical and social.
There is no age limit to this surgery and we have operated on people in their 5th and 6th decades for this condition.:
Following a thorough consultation and examination patients are usually referred for a sleep study and we advise the patients to see us first to assess and then refer to a reputable sleep study centre. Patients are assessed thoroughly before embarking on this treatment and are offered the surgery only if deemed that it will be of benefit. Some patients unfortunately cannot be treated surgically and CPAP is the only other alternative, other than for mild cases where a mandibular advancement splint may suffice or be used in conjunction with CPAP. We go through all these options.
As one of the largest volume orthognathic surgeons in London, Mr Heliotis has managed OSA patients successfully, having a substantial amount of experience in the critical area around preparing such cases. From planning for optimal advances, balancing functional outcome with facial aesthetics and the hospital resources to look after as in-patients with experienced anaesthetic, high dependency and recovery staff looking after such patients