I have seen quite a few adults recently with severe Obstructive Sleep Apnea. So, I just wanted a quick review of common symptoms in patients with OSA. You can see on the x-ray below how airway narrows in a maxillary retrusive patient and the photo shows typical adult with venous pooling.
Common Symptoms of patients with OSA:
Loud or frequent snoring
Silent pauses in breathing
Choking or gasping sounds
Daytime fatigue, difficulty staying awake during the day
Also, look for venous pooling under the eyes
The most common treatment for adults with Obstructive Sleep Apnea is the CPAP. Most of these patients are overweight and many have high blood pressure. Treatment of OSA can change their life. In patients with a mandibular retrusion, dental appliances to advance the mandible have shown good success. These should be full coverage appliances so you do not change the occlusion. Appliances without posterior coverage can create anterior open bite by allowing posterior eruption. Appliances without anterior coverage can contribute to deep bites.
We have had several maxillary deficient patients that have had maxillary advancement and this has drastically improved their airway and OSA.
There are many factors in OSA. There is not one answer for all patients. Everyone can benefit from exercise, weight loss and a healthier lifestyle but not everyone is a candidate for surgery, intraoral devices, etc.
In younger patients it is important to remember snoring is not normal. In younger patients, sleep apnea is generally not related to obesity and blood pressure but rather airway deficiency. Often maxillary expansion and/or mandibular advancement appliances may have a positive effect on sleep apnea. They should also be evaluated with sleep study as well as an evaluation for allergies. These patients will usually have the typical high arch palate, narrow maxilla, and venous pooling under the eyes.