Orthognathic surgery in the treatment of obstructive sleep apnea

Obstructive sleep apnea is an emerging pathology already considered a public health priority due to its growing importance in both adults and children. Advances in the study of sleep have made it possible to describe the problem and understand its consequences.

What is sleep apnea?

Sleep apnea is a sleep disorder that affects approximately 4% of the population. It is due to repeated episodes of upper airway obstruction that occur while the affected person sleeps and lead to apnea, a temporary interruption of breathing of more than ten seconds. The duration of apnea is variable, as is the number of apneas per hour. If more than 30 occur, the problem is considered severe. Breathing is restored by loud snoring, which is a clinical sign.

Types and causes of sleep apneas

Obstructive sleep apnea, which is the most common and the easiest to treat, is caused by an increase in the size of the tissues surrounding the airway, as in the case of obese patients, and their relaxation during sleep.

Central apnea occurs because the brain stops sending respiratory stimuli and in mixed apnea both types are combined.

Other problems that are frequently associated are obesity, a large tongue, presence of large tonsils or vegetations in children, nasal obstruction, large soft palate and position disorders of the maxillary and mandibular bones that are very retracted, that is, the so-called bird face.

Diagnosis of sleep apneas

One of the first signs is daytime drowsiness, the patient tends to fall asleep in unusual situations. Another important sign is loud snoring preceded by respiratory arrest in a person who is a restless sleeper and reports daytime fatigue.

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The definitive diagnosis is obtained after a monitored sleep study, called polysomnography. This test confirms the diagnosis and allows us to assess the severity.

Treatment of sleep apneas

The initial phase of treatment includes a series of recommendations and changes in lifestyle habits, since certain behaviors can aggravate the problem. The advice given by specialists in Maxillofacial Surgery are: avoid alcohol, lose weight by following a healthy diet, do not smoke, avoid sleeping on your back, maintain constant sleeping habits, review your medication with your family doctor, taking into account above all to avoid drugs that relax the nervous system; do daily physical exercise, among others.

Devices that keep the airway open may also be indicated: intraoral mandibular advancement devices or continuous positive airway pressure devices (CPAP).

In more severe cases, or those that do not tolerate this type of devices, we resort to surgery. Thanks to it we can act on the palate and/or tongue, although orthognathic surgery for maxillary and mandibular advancement is currently the best option, since it achieves spectacular results in the remission of this serious health problem.