Knoxville Obstructive Sleep Apnea (OSA)
Dr. Jason Hall was trained in craniofacial and sleep surgery at Stanford University Medical Center, where many of the procedures for the surgical treatment of sleep apnea were developed, and has chosen to make the surgical treatment of obstructive sleep apnea a major focus of his practice.
The purpose of this page is to educate you about Obstructive Sleep Apnea treatments and the surgery options of the disease.
Obstructive Sleep Apnea (OSA) is a breathing disorder that occurs during sleep. Once we fall asleep, the body’s muscles relax and lose normal “resting tone”. In people with obstructive sleep apnea, this loss of muscle tone causes upper airway to collapse and cut off a person’s breathing. As this happens, the brain senses the lack of oxygen and causes the person to wake slightly in order to resume normal breathing again. These episodes (known as arousals) can occur hundreds of times per night without the person ever being aware of them. This is known as Obstructive Sleep Apnea, and it is no surprise that with hundreds of brief periods of awakening each night, people suffering with this syndrome never get the benefit of a restful night’s sleep.
OSA is estimated to affect over 20% of the adults and 5-10% of children in the United States, and is known to cause a variety of life-threatening health problems including: daytime sleepiness, narcolepsy, impaired memory and concentration, high blood pressure, heart attacks, and strokes.
Unfortunately, OSA is an under-diagnosed disease, with approximately 80-90% of adults who suffer from this disorder going undiagnosed.
If you suspect that you have OSA, a referral to a certified sleep medicine physician is the first step in Knoxville sleep apnea treatment. You will then undergo a polysomnogram (or “sleep study”) to determine the severity of your disease. For most patients with OSA, a nasal CPAP machine will be the first step in treatment. This is arguably the most common form of treatment for OSA. However, as you may find, compliance with the device is problematic, and even “regular wearers” of the CPAP machine only wear the device 50% of the recommended time. For this reason, surgical treatment should be considered by anyone suffering from OSA.
Established indications for surgical correction of OSA are:
1. Moderate-severe OSA
2. Severe daytime sleepiness (despite a low AHI)
3. OSA with co-morbid medical conditions (heart arrhythmias, high blood pressure, etc)
4. OSA with anatomic airway abnormalities
5. Failure of non-surgical therapy
Surgical treatment for obstructive sleep apnea treats the underlying anatomic cause of night-time airway obstruction and can reduce or eliminate the need for CPAP. There are numerous procedures that can be performed to reduce airflow resistance and open the airways.
Tracheostomy: A tracheostomy is a hole created in the windpipe of the neck that serves to bypass the site of upper airway obstruction. Most patients will have a resolution of their symptoms and improvements in their sleep studies with this procedure. However, a tracheostomy leaves a hole in the front of the neck, and the social stigma leads many patients with OSA to refuse this type of treatment. It is also not without serious long-term complications, such as tracheal stenosis, life threatening bleeding, and recurrent bronchitis.
Tonsillectomy: Removal of tonsils and adenoids is the first-line treatment for OSA in children and is successful in over 60% of these patients. Children with residual symptoms following tonsillectomy may be candidates for skeletal surgery to correct the remaining airway anomalies.
Uvulopalatopharyngoplasty (UPPP): This procedure benefits patients who have excess soft tissue of the soft palate and uvula, which is identified by a combination of direct physicial examination with or without an endoscopic airway evaluation. In this procedure, the tonsils are removed and the walls of the pharynx are tightened. Although this procedure is one of the most common sleep apnea surgeries performed in the United States and is a good treatment for snoring, it has a success rate in patients with OSA is between 40 and 60%, with a surgical cure rate* of around 16%. Most patients with anatomic airway anomalies treated with a UPPP will have a recurrence of symptoms within 5 years.
Genioglossus advancement: Muscles of the tongue base are advanced forward on a small piece of bone attached to the mandible. This serves to enlarge the hypopharyngeal airway and is commonly combined with other surgical procedures to correct a small airway.
Hyoid myotomy: This procedure also advances the muscles of the tongue base forward, which serves to pull the tongue base away from the back of the throat and enlarge the airway. This procedure is also rarely performed by itself, and is combined with other procedures that enlarge this portion of the airway. The drawback is that it leaves a visible scar on the front of the neck and has a marginal success rate (around 55%).
Maxillomandibular advancement (MMA): This procedure produces the most profound effects on patients with OSA. The bones of both the upper and lower jaw are cut and advanced forward. This serves to treat OSA in two ways – not only does it physically enlarge the airway, but it puts the muscles of the airway under constant tension, which reduces their “floppy” quality which greatly contributes to airway collapse. This procedure has a success rate of 90% and a surgical cure rate of almost 50%. It has been shown to improve not only sleep apnea, but also a number of the medical problems associated with sleep apnea: high blood pressure, daytime sleepiness, depression, memory or concentration impairment, and overall sleep-related quality of life (including productivity, activity level, physical intimacy, and sexual relationships). Unlike surgery on the soft tissue only, recurrence of symptoms after skeletal advancement over long periods of time is rare. In addition, many patients (90%) experience an improvement in their facial appearance after undergoing surgery. Patients who desire a single-stage surgical correction of their OSA and young patients who require long-term symptom resolution of their sleep apnea should consider MMA as their first treatment option.
Distraction osteogenesis: Distraction of the lower jaw is a common treatment for neonates and young children with severe skeletal abnormalities which results in airway obstruction. It is commonly used for children with Pierre Robin sequence, Treacher Collins syndrome, and hemifacial microsomia. Surgical incisions are made in the lower jawbone and devices are placed over these incisions which slowly “stretch” the bones, resulting in a larger, more anatomically normal bony shape. This procedure can help children avoid a tracheostomy and it’s long-term complications, and helps to restore a more normal physical appearance to these children, as well. Distraction osteogenesis can also be used in adults with scarring from prior surgeries and those with severe bony abnormalities which were previously uncorrectable.
* A surgical “cure” for OSA is defined as an AHI (apnea-hypopnea index) of <5/hr in adults and <1/hr in children or a 50% reduction in AHI after surgery.
If you have any questions about Knoxville sleep apnea treatments, solutions & surgery or would like to meet with Dr. Hall to discuss your options, call 865.973.9500 or use our contact form and request an appointment. For out of town patients, feel free to request an online consult via Skype.