The treatment options always begin with conservative treatment. Trinity Health in Ann Arbor offers 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.

Drug Induced Sleep Endoscopy (DISE) has been used as part of the evaluation of patients with sleep apnea for over 30 years. DISE is performed to assess the airway with patients in a state of artificial sleep. The procedure is perform in the operating room using twilight anesthesia – similar to a colonoscopy.  The surgeon evaluates the airway and creates a surgical plan based on the findings. Evaluation of the airway under sedation has been shown to reveal areas of obstruction at the back of the tongue and voice box that are not seen during the office examination. These observations can dramatically influence the type of surgery that may be recommended. DISE can also determine whether you are a candidate for surgery.

Patients with obstructive sleep apnea can be categorized as mild, moderate, or severe based on the results of a sleep study. For patients with mild OSA the obstruction is usually due to obstruction at one site (large tonsils, nasal congestion). For patients with moderate to severe OSA the pattern of obstruction is typically more complex, involving the nose, palate, and tongue. In some cases the jaw may also be factor in patients with a an overbite. Sites of obstruction are initially identified in the office and then confirmed in the operating room during sedated endoscopy (DISE).  The surgeon will formulate a treatment strategy based on the accumulated evidence including office exam, DISE, sleep study, and an x-ray of the jaw.  Multilevel surgery has been found to improve the chances of success in patients with moderate to severe OSA. The surgery may be done in stages to best optimize results. Go to Hoffroboticsurgery.com for details.

Patients with sleep apnea who are intolerant of traditional therapy such as CPAP or those who have failed other treatment modalities may be candidates for the Inspire hypoglossal nerve stimulator. This device is similar to a pacemaker. A device is implanted in the chest that detects pauses in breathing and provides stimulation to the tongue muscle, preventing it from falling back and blocking the air passage.  This device has been approved by the FDA and thousands of patients have undergone this surgery around the world. Ascension Health System is one of three hospitals in the Michigan performing this surgery. In order to be a candidate, patients must have body mass index (BMI) of 32 or less and have moderate to severe sleep apnea.  In addition, patients considering this procedure will need to undergo a sleep endoscopy (DISE) to establish candidacy. The inspire device has cure rates of over 50% with more than 70% of patients able to discontinue CPAP.  Snoring resolves in over 85% of patients. Better yet, 85% of patients continue to use the device after 3 years. For more information, go to https://www.inspiresleep.com.

Patients with sleep apnea who are intolerant of traditional therapy such as CPAP or those who have failed other treatment modalities may be candidates for the Inspire hypoglossal nerve stimulator. This device is similar to a pacemaker. A device is implanted in the chest that detects pauses in breathing and provides stimulation to the tongue muscle, preventing it from falling back and blocking the air passage.  This device has been approved by the FDA and thousands of patients have undergone this surgery around the world. Trinity Health System is one of three hospitals in the Michigan performing this surgery. In order to be a candidate, patients must have body mass index (BMI) of 32 or less and have moderate to severe sleep apnea.  In addition, patients considering this procedure will need to undergo a sleep endoscopy (DISE) to establish candidacy. The inspire device has cure rates of over 50% with more than 70% of patients able to discontinue CPAP.  Snoring resolves in over 85% of patients. Better yet, 85% of patients continue to use the device after 3 years. For more information, go to https://www.inspiresleep.com.