Approximately 18 million adults have obstructive sleep apnea (OSA). Patients with this condition experience low sleep quality, sleep disturbances and daytime drowsiness. Studies have shown that chronic sleep disruption can lead to depression, stroke, heart disease and diabetes.
Sleep apnea is under-reported and under-diagnosed. Among patients with confirmed OSA, only 42 percent use positive airway pressure (PAP) devices as recommended. Compared to breathing devices that are not well tolerated and further decrease sleep quality, surgical procedures are an attractive and highly effective second-line option.
What is Obstructive Sleep Apnea?
OSA occurs during sleep when the tongue relaxes and blocks the airway by falling against the back of the throat. Breathing through the nose or the mouth is ineffective if the airway is obstructed. When this occurs, the brain sends signals that trigger the patient to wake up partially and move the tongue. Patients with sleep apnea stop breathing for 10 seconds to a minute. Low oxygen levels strain the circulatory system and can lead to heart disease or even premature death. This pattern of airway obstruction can occur a dozen times per hour or as often as a hundred times a night. Upper airway resistance syndrome (UARS) is a related but less severe condition that causes similar symptoms.
Sleep Apnea Evaluation and Diagnosis
Because episodes occur in an unconscious state, individuals are often unaware of the disturbance unless someone else mentions the behavior. After seeking medical care, patients may finally understand the reason for their previously unexplained daytime drowsiness. Although doctors can diagnose patients based on symptoms, insurance companies require official reports from sleep specialists to authorize treatment.
Comprehensive sleep evaluations and polysomnograms can be completed in the patient’s home or at a medical facility. By monitoring the frequency of obstructions, specialists can make a diagnosis based on the patient’s apnea-hypopnea index (AHI), which measures the number of events.
Surgical Treatments for Sleep Apnea
Surgery is an effective solution when breathing machines, oral devices, therapeutic pillows and other first-line treatments are ineffective. Several second-line procedures are available depending on the cause of the OSA.
- Tonsillectomy is a medically necessary procedure when enlarged tonsils or adenoids cause nasopharyngeal obstruction. One study found that OSA was reduced in all patients and 64 percent were cured with tonsillectomies.
- Uvulopalatopharyngoplasty (UPPP) is an effective procedure for expanding the oropharyngeal air space by reshaping the uvula, soft palate, tongue, pharynx and pharyngeal pillars. UPPP is sometimes combined with tonsillectomy and tongue channeling. One study found that 97 percent of patients were satisfied with the outcome, but 65 percent needed additional sleep apnea treatments.
- UPPP can be completed with assistance from lasers. This is an outpatient procedure that’s preformed with IV sedation. Laser-assisted uvulapalatoplasty (LAUP) is a newer surgical technique that’s similar to UPPP. It’s frequently used to control chronic snoring. Insurance companies do not recognize LAUP as a medically necessary procedure for snoring or sleep apnea.
- Orthognathic surgery is a highly effective option for controlling sleep apnea and significantly increasing the upper airway volume. Maxillomandibular advancement surgery is indicated in cases where a surgically correctable abnormality causes OSA. Because jaw advancement will produce significant changes in the structure of your bite, you may need to wear braces before and after the surgery. Dr. Majid Jamali will work closely with you and your orthodontist to ensure an optimal outcome.
Will My Insurance Cover Jaw Surgery?
Insurance companies will pay for corrective surgeries if they are deemed medically necessary. Generally, patients must meet the following requirements before the insurance company will pay for oral maxillofacial surgery.
- You must complete a sleep evaluation.
- The results must show an AHI index of 15 events per hour.
- You must have at least 30 events during the study.
- Nonsurgical first-line therapies must have failed.
- CPAP therapy and oral appliances must be ineffective.
Your insurance company will authorize coverage on an individual, medically necessary basis. Dr. Jamali and our office staff will work with you and your insurance company to minimize out-of-pocket expenses based on your medical history and the severity of your symptoms. Orthognathic surgery generally requires separate approval and review by your insurer’s oral and maxillofacial surgery unit. We will provide information to establish a medical need when appropriate.
What to Expect During Jaw Surgery for Sleep Apnea
During your initial consultation, Dr. Jamali will assess the anatomy of your throat and mouth to determine the cause of your OSA symptoms. This evaluation may include a skull X-ray or a nasopharyngeal exam to determine whether orthognathic surgery can correct the problem by widening the airway. In patients with jaw asymmetry and difficulty chewing, biting or swallowing, surgery can successfully reposition the jaw. To correct a large overbite or a weak chin, the lower jaw may be advanced forward. In patients with a strong underbite, the jaw can be shortened and realigned. The surgery may focus on the upper jaw, the lower jaw or both. Dr. Jamali uses computer imaging so that you can see the results before surgery.
While UPPP and LAUP procedures are completed in the doctor’s office, orthognathic surgery is performed in the hospital. You will be moved to a pre-surgery room where you will meet the anesthesiologist. Then, you will be transported to the operating room. The surgery will last for two to four hours depending on the procedure. In most cases, patients stay in the hospital for one or two days.
Recovery after Jaw Surgery
During the first week, you will experience swelling, bruising and congestion. Dr. Jamali will give you a prescription medication to control the pain and inflammation. You will complete a course of antibiotics to prevent infection. Keeping your mouth clean is critical. You will use a baby toothbrush and an antiseptic rinse to clean your teeth, tongue and any splints and wires that are stabilizing the jaw. You should rinse with warm salt water several times a day.
Diet is important during recovery. Stay hydrated by drinking sugar-free beverages, including water, broth and tea. Limit yourself to liquid foods for one week. Then, incorporate pureed foods, such as yogurt and soup, in your diet. Foods that don’t require chewing are ideal for the first month. You can gradually add normal foods back into your diet after six weeks.
Approximately one week after the surgery, you will visit Dr. Jamali for a follow-up appointment. By this time, the majority of the swelling will have subsided. If you work in an office, you can most likely return to your job at this point. Patients should avoid strenuous work and heavy lifting for the first six weeks. Vigorous activities increase blood pressure, which can result in swelling or bleeding. As a board-certified oral and maxillofacial surgeon, Dr. Jamali may provide additional advice to promote healing.
Scheduling a Consultation
Surgical sleep apnea treatments can improve your overall health. Past patients have discovered restful, uninterrupted sleep and freedom from obtrusive CPAP machines. If you’re considering surgery for obstructive sleep apnea, contact Oral & Maxillofacial Surgery of New York by calling 212-480-2777. We have helped patients in Manhattan, Westchester, Queens, Staten Island, Brooklyn and the Bronx. Dr. Jamali can answer your questions and explain treatment options during a private consultation.