SLEEP APNOEA
WHAT IS SLEEP APNEA
Obstructive Sleep Apnea Syndrome (OSAS) is considered a respiratory disorder capable of compromising sleep quality, as it is characterized by recurrent nighttime micro-awakenings and breathing pauses that can lead to functional, neurocognitive, and psychosocial changes.
The syndrome is particularly prevalent among middle-aged and elderly adults, although the mechanism by which the upper airway collapses is not fully understood. It is known that OSAS is a multifactorial condition related to factors such as sex, age, obesity, chronic tobacco and alcohol consumption, hereditary and congenital diseases, altered muscle function of the upper airway, and craniofacial changes.
What are the associated clinical features?
The clinical characteristics of OSAHS can be classified as daytime and nighttime. Among them are the following:
- excessive sleepiness;
- hyposalivation (decreased salivary flow);
- gastroesophageal reflux;
- impotence;
- irritability;
- depression;
- lack of attention and concentration;
- headaches;
- restless sleep;
- nighttime snoring;
- sweating.
What are the main associated complications?
The main complications associated with OSAHS include the risk of laboratory and vehicular accidents, primarily resulting from excessive daytime sleepiness.
However, OSAHS is also associated with the onset or development of cardiovascular problems such as: hypertension, diabetes mellitus, stroke, arrhythmia, and heart failure.
How is the diagnosis made?
SAHOS is classified through the Apnea-Hypopnea Index (AHI) into three levels of severity (mild, moderate, severe), which corresponds to the sum of the number of apneas and hypopneas divided by the total number of hours of sleep. Therefore, the preferred diagnosis method is polysomnography; however, nocturnal oximetry, cephalometry, or the Epworth Sleepiness Scale are also applicable diagnostic tools.
Relationship between orthognathic surgery and OSAHS:
In patients with mandibular retrusion, it is common to observe a significant reduction in the pharyngeal airway space, which can result in limited airflow due to this anatomical alteration. The surgery to advance the mandible and simultaneously the chin leads to the forward positioning of the tongue from the posterior wall of the pharynx and a contraction of the tongue musculature along with that of the soft palate. This skeletal alteration creates a modification of the oral cavity muscles, limiting the possibility of collapses and resulting in an increase in airflow through the airways.
With the bone restitution of the maxillomandibular complex, it is expected that the surgical outcomes will provide patients with an improvement in their quality of life, as the surgery will allow for proper mouth closure, compatible with better masticatory, respiratory, and phonation functions.
