Obstructive Sleep Apnea Syndrome (OSAS) is caused by obstruction of the airway (throat). It is characterised by repeated pauses in breathing during sleep. These pauses or episodes of asphyxia can occur dozens of times during sleep and they are associated with daytime sleepiness and chronic fatigue, which have been demonstrated as being responsible for occupational and traffic accidents. Another of the consequences of sleep apnea is a reduction of the quantity of oxygen carried in the blood, leading to high blood pressure and cardiovascular and cerebrovascular problems.
The signs typically associated with sleep apnea and that facilitate its diagnosis are snoring, the breathing stopping during sleep, tiredness and chronic fatigue. The presence of two of the above symptoms and the absence of other causes should lead to suspect Obstructive Sleep Apnea Syndrome and would justify a sleep study.
As for the rate, up to 25% of the population is affected by sleep apnea according to various statistics and 4-5% of the population suffers from severe cases of this illness.
Sleep Apnea diagnosis is made by a test known as a polysomnography, which consists of using special devices to monitor several variables during sleep.
As for the treatment, the first level of action consists of losing weight – if the patient is overweight-, stopping the consumption of alcohol and large meals before bed and avoiding sleeping on the back –which tends to cause the airway to collapse.
The second level of action is usually called CPAP (continuous positive airway pressure). It consists of a mask connected via tubes to a machine that continuously supplies the patient with high pressure oxygen.
Patients usually find it very difficult to have to be connected for life to an uncomfortable mask and a noisy machine each night.
Orthognathic surgery has demonstrated its benefits in the treatment of Obstructive Sleep Apnea. Advancement of the maxilla, mandible or both makes it possible to notably increase the diameter and volume of the airway (the throat), allowing patients to stop using CPAP.
Experience of the Institute
The Instituto Maxilofacial of Barcelona performed a study on 30 consecutive patients who had undergone orthognathic surgery involving mandibular, maxillary or bimaxillary advancement, achieving a 70% increase of the airway. All patients in this study who were suffering from Obstructive Sleep Apnea and who were connected to CPAP were able to stop using this “infernal”, (in the words of many patients) device thanks to the increase in the size of the airway achieved by the operation. This study was published by Dr. Hernández Alfaro Journal of Oral and Maxillofacial Surgery
To determine whether a patient could benefit from orthognathic surgery involving mandibular, maxillary or bimaxillary advancement, in addition to a clinical and radiological study, we designed a removable dental device (that can be inserted and taken out), which makes the jaw move forward slightly by moving it out of its position in the joint. If the use of this “mandibular protrusion” device leads to an improvement and reduction in the number of apnea episodes, this is a good indicator that orthognathic surgery will be useful for this specific patient.
The reason why these dental devices cannot be used indefinitely is because continuous protrusion of the jaw could end up damaging the joints.
One of the reasons why many patients are reluctant to undergo orthognathic surgery as a solution to their obstructive sleep apnea is their fear of traumatic or aggressive surgery.
At the Instituto Maxilofacial of Barcelona, Dr. Hernández Alfaro and his team have developed various techniques that allow them to perform minimally invasive orthognathic surgery. Thus, jaw advancement surgery is carried out at the Instituto Maxilofacial under local anaesthetic and sedation.
Until recently, one of the disadvantages of carrying out orthognathic surgery on patients with Sleep Apnea Syndrome was that they first of all needed orthodontic treatment for more than a year in order to prepare the dental arches. Thanks to the Surgery First protocol, these patients can be operated on immediately and solve their breathing problem and the orthodontic treatment can be carried out after the surgery.