Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a severe sleep disorder characterized by repeated episodes of complete or partial obstruction of the upper airway during sleep, leading to disrupted breathing patterns and reduced oxygen intake. In orthodontics, OSA is of particular concern due to its association with craniofacial abnormalities, such as a narrow or recessed airway, enlarged tonsils, or a retruded lower jaw, which can contribute to airway obstruction. Orthodontists play a crucial role in managing OSA by evaluating and addressing underlying anatomical issues that may contribute to sleep-disordered breathing. Treatment approaches may include orthodontic appliances to expand the dental arches, reposition the jaws, or optimize facial structure to alleviate airway constriction and improve breathing patterns during sleep, promoting better overall health and quality of life. 

Symptoms of Obstructive Sleep Apnea

• One of the most noticeable symptoms of obstructive sleep apnea (OSA) is loud and chronic snoring. This snoring is typically persistent and can disrupt bed partners' sleep or even be heard from other rooms. Unlike occasional snoring, the snoring associated with OSA often has irregular patterns. It is punctuated by pauses in breathing, which may be followed by gasping or choking sounds as the person struggles to breathe. 

• Another key symptom is the observed episodes of breathing pauses, known as apneas. These apneas can last 10-30 seconds or longer and occur repeatedly throughout the night. Bed partners or family members often notice these breathing interruptions, as they may observe the individual stop breathing and start again with a gasp or choking sound. This cycle can repeat multiple times an hour, severely disrupting sleep. 

• Individuals with OSA often experience frequent nighttime awakenings. These awakenings are typically abrupt and may be accompanied by choking or gasping as the person resumes breathing after an apnea event. The multiple arousals lead to fragmented sleep, preventing the person from reaching deep, restorative sleep stages. 

• Restless sleep is a common symptom characterized by frequent tossing and turning. People with OSA may find it difficult to stay asleep, often waking up feeling as if they haven't slept at all. This restlessness can result in persistent insomnia, making it hard to get a good night's rest. 

• Night sweats are also a symptom of OSA, where individuals experience excessive sweating during sleep. They may wake up drenched in sweat, often due to the body's response to the stress of repeated awakenings and breathing difficulties. 

• One of the hallmark daytime symptoms of OSA is excessive daytime sleepiness. Despite seemingly adequate sleep duration, individuals with OSA often wake up feeling unrefreshed and may feel overwhelmingly sleepy during the day. This can lead to difficulties staying awake at work, school, or while driving, significantly impacting daily life and increasing the risk of accidents. 

• Persistent fatigue is another common symptom. Individuals with OSA may feel mentally and physically exhausted throughout the day, struggling to find the energy for everyday activities. This chronic tiredness directly results from poor-quality sleep caused by frequent awakenings at night. 

• Those with OSA frequently report morning headaches. These headaches are often due to oxygen deprivation and the buildup of carbon dioxide during sleep, leading to discomfort and grogginess upon waking. 

• Waking up with a dry mouth or sore throat is a common complaint. This symptom is often caused by mouth breathing during sleep, which can dry out the mouth and throat, leading to irritation and discomfort. 

Orthodontic Management of Obstructive Sleep Apnea 

Mandibular Advancement Devices (MADs)

MADs are custom-made oral appliances worn during sleep to reposition the lower jaw (mandible) forward. By advancing the mandible, MADs prevent the tongue and soft tissues from collapsing into the airway, maintaining airway patency throughout the night. Due to their noninvasive nature, MADs are effective for mild to moderate cases of OSA and are well-tolerated by patients. 

Tongue-Retaining Devices

Like MADs, tongue-retaining devices are oral appliances designed to hold the tongue forward during sleep. By preventing the tongue from falling backward and obstructing the airway, these devices help improve airflow and reduce the incidence of apneas and hypopneas (pauses in breathing) characteristic of OSA. 

Palatal Expanders

Palatal or rapid maxillary expanders are orthodontic appliances that widen the upper dental arch and palate. By creating additional space in the oral cavity, palatal expanders alleviate crowding of the tongue and allow for improved nasal breathing. This expansion can help reduce airway resistance and facilitate better airflow, particularly in individuals with a narrow maxilla (upper jaw). 

Orthognathic Surgery

In severe cases of OSA with significant craniofacial abnormalities, orthognathic surgery may be recommended. This surgical procedure involves repositioning the upper and lower jaw to correct skeletal discrepancies contributing to airway obstruction. Orthognathic surgery aims to create a more balanced facial profile and improve the alignment of the upper airway, thereby reducing the severity of OSA symptoms. 

Obstructive Sleep Apnea is a complex sleep disorder that requires comprehensive evaluation and management to improve sleep quality, overall health, and quality of life. Visit Dental Specialists of New York PC at 150 East 58th Street, New York, NY 10155, 110 York Street Brooklyn, NY 11201, or 476 48th Street, 3rd Floor Brooklyn, NY 11220, to discover how orthodontic solutions can help manage Obstructive Sleep Apnea and enhance your quality of life. You can schedule an appointment online or call us at (212) 661-2192.