The treatment options always begin with conservative treatment. Here at St. Joseph Mercy in Ann Arbor we offer a medical weight loss program (HMR) for those overweight and obese patients who suffer with OSA. The next step is the use of either mandibular advancement devices (seen above) or tongue retention devices. We work with a number of dentists with expertise in sleep dentistry (www.reginadailey.com/ and jamesstewartdds.com/) who can help many patients with mild to moderate obstructive sleep apnea.
For patients with severe obesity (BMI >40) Bariatric surgery offers an opportunity to both lose weight and improve obstructive sleep apnea. In rare cases of severe life threatening OSA a tracheostomy may be recommended. Although tracheostomy is rarely performed as a long term solution for OSA, it does have a cure rate of 100%. Tracheostomies are readily reversible should a patient lose weight or undergo other surgery to address OSA.
The surgical treatment of sleep apnea is varied depending on the site and nature of the obstruction. For patients with a recessive jaw (retrognathia) the best option is a bi-maxillary advancement (moving the upper and lower jaw forward) which is performed by oral and maxillofacial surgeons. For all other types of obstruction surgery is typically performed by an otolaryngologist. The key to successful surgery is to identify and address the site(s) of obstruction before surgery.
Sleep endoscopy allows the surgeon to examine the patient’s airway during drug induced sleep using a small fiberoptic scope inserted through the nose. This procedure helps to identify hidden areas of obstruction that may not have been recognized during the office examination. Most patients have obstruction in the area of the palate, tonsils (if present) and the back of the tongue (lingual tonsils and epiglottis). After sleep endoscopy the patient and his or her family are given the opportunity to review video of the procedure and discuss options, expected outcomes, and associated risks. A list of commonly performed procedures can be found in information about surgery. These procedures include surgery on the nose (septoplasty and turbinate reduction), palate surgery, tongue surgery (Robotic surgery or Coblation tongue base surgery), and most recently the Inspire hypoglossal nerve stimulator.