What causes obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is the repeated partial or full collapse of the upper airway during sleep. This can happen many times during the night, resulting in disturbed sleep and increased sleepiness during the day.
For the majority of sufferers, OSA is caused by being overweight; excess fat puts pressure on the airway increasing its likelihood to collapse during the night. But not everyone with OSA is overweight; some have a narrowed airway because of increased soft tissue in the upper airway or something called retrognathia, which is when the lower jaw is set further back than the upper jaw (which reduces the space in the airway).
What is the best treatment for obstructive sleep apnoea?
There are a few different treatment options for OSA – the most common being Continuous Positive Airway Pressure (CPAP); a machine which delivers air pressure via a mask on the face to splint open the airway. CPAP is often quoted as the ‘GOLD standard’ treatment for OSA – it is usually the most effective treatment and will likely be recommended for you to try before any alternative.
Another treatment is a Mandibular Advancement Splints (MAS), mouthguards which can be custom made by specialised dentists to pull forward the lower jaw and increase the space in the upper airway. This option is not suitable for everyone and even in those who are deemed suitable you might get the MAS made up and find that it does not sufficiently treat your OSA.
There are a few surgeries to treat OSA, involving the removal of soft tissue in the upper airway or trimming the tongue. Another surgery repositions the lower jaw.
The treatment you are recommended will depend on your individual presentation based on things like weight, tonsil size, how much space you have in your airway, if moving forward your jaw actually increases your airway, suitability for an operation etc….Ask your sleep physician what they recommend for you.
What is the difference between sleep apnea and obstructive sleep apnoea?
There are a few types of sleep apnoea. Obstructive sleep apnoea is when the airway ‘obstructs’ ie the airway is physically closed which is preventing breathing.
Another kind is central sleep apnoea (CSA). With this kind of sleep apnoea the airway is open and clear but there is no signal from the brain to the lungs to take a breath. This type of sleep apnoea can be common in those with heart conditions or on drugs which can affect the respiratory control centre in your brain (normally opioids). This is much less common than OSA.
Most of the time, when you read ‘sleep apnoea’, the writer will be talking about obstructive sleep apnoea.
Can obstructive sleep apnoea be cured?
For most people, obstructive sleep apnoea is caused by excess weight. There is no evidence that OSA will be completely cured following weight loss either from dietary changes or bariatric surgery, however it will become less severe and sleepiness will improve1.
With upper airway surgery, you are aiming to cure the sleep apnoea by permanently widening the space in the upper airway. The success rate with surgery varies between the different operations from 34% to 87%2.
- Wong A-M, Barnes HN, Joosten SA, et al. The effect of surgical weight loss on obstructive sleep apnoea: A systematic review and meta-analysis. Sleep Medicine Reviews. 2018;42:85-99.
- Garg KR, Afifi MA, Sanchez WR, King WT. Obstructive Sleep Apnea in Adults: The Role of Upper Airway and Facial Skeletal Surgery. Plastic and Reconstructive Surgery. 2016;138(4):889-898.