Obstructive sleep apnea is a common, yet serious, condition that often requires treatment. Mass. Eye and Ear sleep specialist Dr. Phillip Huyett walks Focus through six treatment options for patients.
Obstructive sleep apnea (OSA) is estimated to affect approximately 10 to 25 percent of the population. With OSA, upper airway narrowing or obstruction limits the amount of air that can reach the lungs during sleep, which can lead to serious health problems.
“With obstructive sleep apnea, patients experience airflow limitation, which results in episodic drops in oxygen and fragmented sleep throughout the night,” said Phillip Huyett, MD, a sleep medicine and surgery specialist at Massachusetts Eye and Ear. “This puts significant strain on the heart, which can lead to increased risk of high blood pressure, irregular heartbeats, heart attacks or heart failure.”
Other complications of OSA include strokes, depression, diabetes, difficulty losing weight, decreased quality of life and even increased mortality.
For these reasons, it’s important that those with moderate to severe OSA do not ignore their symptoms and seek treatment. Focus sat down with Dr. Huyett to discuss the most common management options for OSA, and who should consider them.
In some instances of OSA, changes in lifestyle can be a stand-alone treatment or used in combination with other therapies. These might include making changes to your “sleep hygiene,” such as shutting off all electronic devices before sleep to allow adequate sleep opportunities, avoiding sedatives and alcohol before bed and trying new sleep positions to improve breathing.
“Whether it’s trying positional therapy, losing weight or improving sleep hygiene, a person with sleep apnea might find significant benefit in simple changes,” Dr. Huyett said.
PAP (Positive Airway Pressure)
The use of a PAP machine (including the popular CPAP), which delivers positive pressure through the nose and/or mouth to stent open the airway and help you breathe, is most often the first line of treatment for OSA. A mask must be worn all night, every night.
According to Dr. Huyett, it’s the option that’s “most effective overall and has the largest amount of research supporting its use. PAP is non-invasive, has a very low side-effect profile and is completely reversible.”
An oral appliance is essentially a mouth guard that’s designed to bring the lower jaw forward to increase the caliber of and stabilize the upper airway. Similar to a PAP machine, this is a completely reversible option, but it also needs to be worn every night.
Dr. Huyett notes that sleep specialists will work with specially-trained dentists to ensure this option is right for patients.
Soft Tissue Surgery
The traditional surgical option, uvulopalatopharyngoplasty (UPPP), consisted of removing the tonsils, the uvula and portions of the soft palate. Modern modifications of this procedure (“expansion pharyngoplasty”) focus on reconstructing the soft palate, rather than removing it, to make the airway wider.
The benefit to definitive soft tissue surgery is the opportunity to sleep free from a mask, mouth guard and nerve stimulation. In addition to the palate and tonsil region, the nose and lower throat can be addressed with soft tissue surgery.
Hypoglossal Nerve Stimulation
For patients with moderate to severe OSA who have failed PAP therapy, hypoglossal nerve stimulation might be a good option. This surgically implanted device delivers electrical impulses that contract your tongue muscles to improve breathing. The device is controlled with a remote and allows patients to sleep free of masks or mouth guards.
Mass. Eye and Ear and Dr. Huyett now offer this treatment option with Inspire Medical Systems©, which has been available since 2014 and implanted in more than 6,000 patients. Patients must be at least 22 years old with a body mass index of less than 35 to be eligible for this procedure.
For some patients, the best treatment option is to expand the size of their facial skeleton. This is known as maxillomandibular advancement (MMA) and is done by highly trained oral maxillofacial surgeons.
This surgery greatly improves OSA, but the recovery time is generally longer than other procedures. It is best for patients who have not had success with other interventions.
OSA is a dangerous condition if left untreated. If you or a loved one snores, which is the most common symptom of OSA, please consult a sleep specialist.
About Our Expert
Dr. Phillip Huyett is a member of the Division of Sleep Medicine and Surgery at Mass. Eye and Ear. He is fellowship trained in sleep medicine, and sees adult and pediatric patients at both of our Boston locations.