[Click! Health] Dangerous Sleep Apnea... Early Treatment Is Necessary

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[Asia Economy Reporter Chunhee Lee] When parents snore while sleeping, there are moments when their breathing temporarily stops and it becomes quiet before they start breathing again. If such symptoms appear, obstructive sleep apnea (OSA) should be suspected.

Sleep apnea literally refers to the condition of stopping breathing during sleep. Although there is central sleep apnea, a neurological disorder where all respiratory efforts cease during sleep, most cases are obstructive sleep apnea or a combination of both types. Among the domestic population aged 40 to 69, 27% of men and 16% of women have sleep-disordered breathing, and the prevalence of obstructive sleep apnea in Korea is known to be 4.5% in men and 3.2% in women. Due to the increase in obesity caused by Westernized diets, aging, alcohol consumption, smoking, and excessive stress, the number of patients continues to rise.

Obstructive sleep apnea causes no breathing problems during the day, but after falling asleep, sufferers experience choking and gasping symptoms. If the upper airway at the base of the tongue narrows or becomes blocked during sleep, causing apnea (breathing stops for more than 10 seconds) or hypopnea (shallow breathing) to occur five or more times per hour, it is classified as sleep apnea. Obstructive sleep apnea not only causes sleep deprivation and chronic fatigue but, if left untreated, increases the risk of hypertension, stroke, deep vein thrombosis, diabetes, and even mortality.

Continuous positive airway pressure (CPAP) is recommended as the first-line treatment for obstructive sleep apnea. However, since using a positive pressure device like an oxygen mask can be cumbersome, patient compliance drops to between 10% and 50%, which is considered a drawback.

Professor Hong Seong-wook, Department of Oral Surgery, Kangdong Kyung Hee University Hospital (Photo by Kangdong Kyung Hee University Hospital)

Therefore, some patients use a simpler oral appliance. This device is worn on the teeth inside the mouth during sleep, advancing the lower jaw forward to widen the narrow airway space and pushing the tongue forward to open the airway, thereby treating obstructive sleep apnea. It is used for patients with snoring or mild to moderate sleep apnea with an apnea-hypopnea index (AHI) below 30 who do not want CPAP or have failed CPAP treatment. However, its use is limited in cases of heart disease, respiratory disease, chronic systemic disease, severe periodontal disease, denture users, temporomandibular joint disorders, or severe nasal sinus disease.

In cases where the palate (hard palate) of the maxilla is narrow, causing nasal breathing problems, rapid maxillary expansion (RME) can widen the palate and improve sleep apnea. This method connects orthodontic appliances to the molars to increase the width of the nasal cavity and palate, improving mouth breathing and reducing airway resistance. It is recommended as an appropriate treatment for children and adolescents aged 5 to 16.

For severe cases or when wearing an oral appliance is difficult, surgical treatment may be considered. Maxillomandibular advancement (MMA) surgery is used for patients with moderate to severe sleep apnea. The surgery is more effective in younger patients with lower apnea-hypopnea index and body mass index, and when a large advancement is performed. Compared to other surgeries, the effects of MMA last longer.

Professor Seongok Hong of the Department of Oral Surgery at Kangdong Kyung Hee University Dental Hospital explained, "Most sleep apnea patients have a retruded lower jaw or a long, narrow adenoid face." She added, "For these patients, treatment can improve both function and appearance." However, she also emphasized that patients with normal facial structures should consult with an oral and maxillofacial surgery specialist to develop an accurate treatment plan.