Dr. Gonzalez Lagunas, a prestigious specialist in Oral and Maxillofacial Surgery, offers details on advances in the approach to snoring and sleep apneas. Dr. González is an expert in temporomandibular joint cases, orthognathic surgery, preprosthetic surgery, dental implants and rhinoplasty. He is currently head of service and medical director of Oral and Maxillofacial Surgery at QMaxDental, Quirón Hospital in Barcelona.
If there is something that can especially ruin our rest is, without a doubt, the sound of snoring. It may seem unimportant, but for those who suffer from it it is a really serious problem, both for him and for his partner. The fact of not being able to rest during the night can cause that, during the day, we have a singular symptomatology, presenting: excessive sleepiness, tiredness or feeling of unrefreshing sleep, headache, irritability, difficulty concentrating, memory loss or changes in character.
What is snoring and why does it occur? What is OSA and what does it consist of?
The snoring noise is produced by the vibration of the soft parts of the oropharynx. The passage of air through the throat causes the surrounding tissues to vibrate because they are “flaccid” or not very tense due to muscular rest and the fall of the tongue, or due to the fact of having a large amount of fatty tissue in the throat. This is what is called simple snoring.
However, it should be noted that snoring is almost always accompanied by a more important disorder called OSA or Obstructive Sleep Apnea Syndrome. This syndrome affects 4-6% of men and 2-4% of women of average age, which increases to 1 in those over 65 years of age.
OSA is a severe sleep disorder and consists of repeated episodes of upper airway obstruction during the deep sleep phase with breathing pauses of between 10 and 30 seconds. This means that we stop getting air into the lungs for those seconds while we are deep asleep. Such breathing pauses are followed by an attempt to breathe and a change to a lighter stage of sleep, as oxygenation decreases and we wake up for between 1 and 3 seconds. Thus, sleep is no longer restorative because it is fragmented. It is for this reason that people suffering from OSAS may also present snoring, apneas, choking episodes, frequent awakenings, insomnia and nightmares, restless sleep, need to urinate or gastroesophageal reflux.
It is worth mentioning that there are some causes or risk factors for suffering OSAS, such as obesity (60% of patients with OSAS are obese), obstruction of the airways by the tongue, tonsils or uvula. So can the consumption of tobacco and alcohol, the use of sleeping medications or lying in the supine position to sleep.
How to diagnose Sleep Apnea Syndrome or OSAS
The diagnosis of OSAS is established with a polysomnography, tests indicated in people who present one or more of the following symptoms:
– Drowsiness, unrefreshing sleep or fatigue.
– Awakening with shortness of breath or choking sensation.
– When a witness describes: habitual snoring and interruptions of breathing during sleep.
– History of: high blood pressure, mood disorders, coronary artery disease, myocardial infarction or type II Diabetes Mellitus.
How to treat snoring and OSA?
The treatment of Sleep Apnea Syndrome will vary according to the case, although whatever the degree of severity of the disorder, experts in Oral and Maxillofacial Surgery establish some common recommendations:
– Lose weight, in case of obesity
– Sleep on your side or on your stomach instead of on your back.
– Avoid tobacco, alcohol and sedatives before going to sleep.
– Try to eat 2-3 hours before going to bed.
Treatments are usually effective, and include:
1) Mandibular advancement device.
These are two splints joined together by means of a screw, which allows the jaw to move forward and increases muscle tone at the level of the airway. The use of these splints facilitates the passage of air and eliminates snoring, improves apnea episodes and, therefore, improves the patient’s quality of life (and rest).
Jaw advancement is performed in a controlled manner and will depend on each patient’s ability to move his or her jaw forward. The objective is to be as comfortable as possible for the patient and, during use, sideways movements can be made, as well as opening the mouth slightly.
2) Maxillomandibular advancement
It is a surgical intervention that consists of simultaneously advancing the maxillary and mandibular bones, in order to enlarge the air space, both in the rhinopharynx (back part of the nose) and in the oropharynx (back part of the mouth).
The operation is performed inside the mouth, without external scars. It consists of performing controlled osteotomies in the bones of the face, to move them forward (generally in the order of 1cm) and then fix them with screws and plates.
This is the treatment with the best results, with a percentage of total resolution of sleep apneas in most cases.