Sleep Apnea
Obstructive sleep apnea (OSA) happens when the airway at the back of the throat repeatedly collapses during sleep, briefly stopping breathing. It is diagnosed with a sleep study. Treatment usually starts with CPAP, a mask that keeps the airway open with gentle air pressure. Oral appliances that hold the lower jaw forward work well for many people with mild to moderate OSA. For selected complex cases, jaw advancement surgery enlarges the airway itself.
Key takeaways
- Loud snoring, witnessed pauses in breathing, and daytime sleepiness are key warning signs.
- A sleep study is essential to confirm OSA and its severity.
- CPAP is the most common first treatment; oral appliances are an option for mild to moderate OSA.
- Maxillomandibular advancement surgery moves both jaws forward and can markedly reduce apnea in selected patients.
- Untreated OSA is linked to high blood pressure and cardiovascular problems.
What Happens During Obstructive Sleep Apnea?
During sleep, the muscles of the throat relax. In OSA, the tongue and soft tissues fall back and block the airway, so airflow stops. As oxygen levels drop, the brain partially wakes the sleeper, the airway reopens, and breathing resumes, often with a loud gasp or snort. This cycle can repeat many times an hour without the person remembering it.
A milder form, upper airway resistance syndrome (UARS), causes similar daytime symptoms with less severe obstruction. Not everyone who snores has OSA, and not everyone with OSA snores.
Are You At Risk? A Quick Screening Check
Answering yes to three or more of these questions suggests a high likelihood of OSA:
- Do you snore loudly enough to be heard through a closed door?
- Do you often feel tired, unrefreshed after sleep, or doze off during the day?
- Has someone seen you stop breathing during sleep?
- Are you being treated for high blood pressure?
- Is your body mass index greater than 35?
- Are you male and over 50?
- Is your neck size greater than 17 inches (40 cm)?
This is a screening tool, not a diagnosis. Talk to your family physician about a sleep study.
Why Treatment Matters
Repeated drops in oxygen during sleep strain the heart and blood vessels and are linked to high blood pressure and other cardiovascular problems. People with OSA also experience daytime sleepiness, poor concentration, low mood, and a higher risk of drowsy driving. Treatment improves sleep quality and daytime function for most patients.
Treatment Options Compared
| Treatment | How it works | Best suited to | Considerations |
|---|---|---|---|
| CPAP | A mask delivers gentle air pressure to keep the airway open | Most patients, as first-line therapy | Very effective when used nightly; some people find the mask hard to tolerate |
| Oral appliance | A custom device holds the lower jaw forward during sleep | Mild to moderate OSA, or CPAP intolerance | Needs dental fitting and follow-up; may affect the bite over time |
| Lifestyle changes | Weight loss, sleeping on the side, avoiding alcohol before bed | Everyone, alongside other treatment | Helpful but often not enough alone |
| Maxillomandibular advancement (jaw surgery) | Upper and lower jaws are moved forward, enlarging the airway | Selected moderate to severe cases, especially with jaw structure contributing | Hospital surgery under general anesthesia with a short overnight stay |
How Do Oral Appliances Work?
Mandibular advancement appliances look like sports mouthguards and are worn at night. They hold the lower jaw, and with it the tongue, slightly forward to keep the airway open. The Klearway appliance, developed by Dr. Alan Lowe at the University of British Columbia, is one example our surgical team may suggest. Oral appliances are often recommended for mild to moderate OSA and for people who cannot tolerate CPAP.
When Is Jaw Surgery Considered For Sleep Apnea?
For more complex cases, especially when the size and position of the jaws contribute to a narrow airway, the upper and lower jaws can be repositioned forward. This is called maxillomandibular advancement (MMA), a form of orthognathic surgery. It is performed in hospital under general anesthesia and usually involves a one- to two-day stay.
A meta-analysis of published studies found that MMA substantially reduced the number of breathing interruptions per hour, with most patients achieving surgical success. Surgery is not the first step for most patients, but it is an important option when other treatments have not worked.
"Maxillomandibular advancement is an effective treatment for OSA." — Zaghi et al., JAMA Otolaryngology–Head & Neck Surgery, 2016
How Assessment Works
- History and screening with your physician or dentist.
- Overnight sleep study to confirm OSA and measure its severity.
- Maxillofacial assessment, including examination of the jaws and airway and cephalometric (skull) X-ray analysis to identify the level of obstruction.
- Treatment discussion with your sleep physician and, where appropriate, the oral and maxillofacial surgeon.
Most major medical plans offer some coverage for diagnosis and treatment of OSA. Check with your plan.
Sleep Apnea Care In Waterloo Region
Oral and maxillofacial surgeons at our office at 96 Union Street East in Waterloo offer consultation for patients with obstructive sleep apnea from Waterloo, Kitchener, Cambridge, Guelph, and Stratford, working alongside sleep physicians. Learn more on our sleep apnea page or read what is an oral and maxillofacial surgeon. For bite-related jaw surgery, see jaw surgery for bite problems. Call +1 (519)-743-7811 to ask about a consultation.
Sources
- Zaghi S, Holty JEC, Certal V, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngology–Head & Neck Surgery, 2016.
- Sleep apnea, Dr. Kevin J. McCann Oral & Maxillofacial Surgery.
FAQ
Can Oral Surgery Cure Sleep Apnea?
Jaw advancement surgery can greatly reduce or, in some patients, resolve obstructive sleep apnea by enlarging the airway. Results vary, and a follow-up sleep study is used to measure the effect.
Is An Oral Appliance As Good As CPAP?
CPAP is generally more effective at reducing apnea, but an oral appliance can work well for mild to moderate OSA and is often easier to use every night. The best treatment is the one you will use consistently.
Do I Need A Sleep Study Before Treatment?
Yes. A sleep study confirms the diagnosis, measures severity, and guides which treatment is appropriate.
How Long Is Recovery From Jaw Surgery For Sleep Apnea?
Patients usually stay in hospital for one to two nights. Swelling and a modified diet are expected for several weeks, and most people return to normal activities over a few weeks to a couple of months.
Does Insurance Cover Sleep Apnea Treatment?
Most major medical plans offer some coverage for the diagnosis and treatment of sleep apnea. Coverage varies, so check with your provider.
This article is general patient education and does not replace an examination, diagnosis, or the written instructions from your own surgeon or dentist. If you have heavy bleeding, trouble breathing or swallowing, or rapidly spreading swelling, call the office or go to the nearest emergency department.