Snoring and Obstructive Sleep Apnoea (OSA)

Obstructive sleep apnoea (OSA) is characterized by repeated episodes of upper airway occlusion during sleep. Signs and symptoms include excessive daytime sleepiness, morning headaches and loss of concentration associated with sleep deprivation. Snoring is the most common presenting complaint with OSA. Risks of untreated sleep apnoea include high blood pressure, stroke, heart disease, and motor vehicle accidents.

OSA in adults

Excessive relaxation of upper airway muscles causes airway collapse and obstruction during sleep. The mandibular advancement device (dental appliance) is worn during sleep. Dental appliances for snoring are small, portable and lightweight. The dental appliance consists of upper and lower splints attached to the teeth which protrude the lower jaw forward. This moves the tongue forwards since the tongue is attached to the lower jaw, preventing the tongue from falling back during sleep. The use of dental appliance has been shown to reduce snoring, improve breathing and increase blood oxygen saturation. This leads to the adult patient feeling more refreshed during the day.

For patients with structural small receding jaw, orthognathic surgery with orthodontics is one of the surgical options to treat OSA. Maxillomandibular advancement surgery includes a number of procedures designed to move the upper jaw (maxilla) and/or lower jaw (mandible) forward, thus opening the upper and/or lower airway, respectively. Although full maxillomandibular advancement surgery can provide effective enlargement and stabilization of the airway, the potential benefits must be cautiously weighed against the potential increased risks of complications, longer recovery, and changes in the cosmetic appearance of the face.

OSA in children.

Children with OSA may display behavior problems or school difficulties as they have problems paying attention in class.

Structural jaw problems may be one of the causes of snoring or sleep disturbances. Early intervention orthodontic procedures to widen the palate (maxillary expansion) or growth modification to guide the jaw growth forwards may be useful treatment options in some pediatric patients.

As OSA is a medical problem with long term health consequences, it is important to have a team approach with medical practitioners. Proper patient and procedure selection is essential for successful management of patients with obstructive sleep apnoea.