Obstructive sleep apnea (OSA) is a major cause of sleep disturbances and potentially life-threatening breathing disorders, and it is typically discovered in overweight patients. But it often is missed during initial surgical consultation in those with certain jaw deformities, particularly if the patient is not overweight, according to researchers at the Posnick Center for Facial Plastic Surgery in Chevy Chase, Md, and Howard University Hospital in Washington, DC.
Obesity frequently is called the cause of OSA, but many patients have a body structure that can result in an upper airway collapse that is characteristic of the condition, the researchers noted. Patients who have the type of jaw deformities that leads to OSA usually can be cured through corrective jaw surgery, the researchers added.
In fact, the researchers found that most of their patients who had initially undiagnosed sleep-disordered breathing and were then confirmed to have OSA had a normal body mass index (BMI) or were underweight. The researchers use the term “silent sleep apnea” to describe these patients and surmise that physicians and dentists who treat them have a lower level of suspicion when it comes to OSA.
The study involved 262 patients with a jaw deformity that often involved a small chin and chronic obstructive nasal breathing. These patients, who underwent surgery, were divided into two groups: those with OSA and those without it.
Of the patients, 23% had OSA confirmed by a polysomnogram, which is higher than the estimated rate of 4% to 5% of OSA in the general population. Also, 7% of the patients had OSA at an initial surgical consultation for jaw surgery, and another 16% were found to have OSA through the sleep study and an evaluation by a pulmonologist. The patients most likely to have OSA were 30 years or older with a higher BMI and a jaw growth pattern behind the proper position, such as a short face or an overbite (primary mandibular deficiency).
After corrective surgery on the jaws, chin, and nasal structures, patients with OSA and chronic obstructive nasal breathing had low levels of daytime sleepiness over the long term. Among patients with OSA, 91% said their daytime sleepiness was “not sleepy” at least one year after surgery.
The excessive daytime sleepiness associated with OSA has been proved to impair quality of life, the researchers reported, including links to excessive moodiness, tendency toward depression, stress-related fatigue, personality changes, headaches, and decreased daytime cognitive function such as poor memory and difficulty concentrating.
The study, “‘Silent’ Sleep Apnea in Dentofacial Deformities and Prevalence of Daytime Sleepiness After Orthognathic and Intranasal Surgery,” was published by the Journal of Oral and Maxillofacial Surgery.
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