Obstructive sleep apnoea
In obstructive sleep apnoea the airway narrows or closes repeatedly during sleep, causing loud snoring, pauses in breathing and daytime sleepiness. Alongside your sleep team, Will offers jaw-based treatments: custom mandibular advancement splints and, for selected patients, jaw advancement surgery.
Who it may help
- Adults diagnosed with obstructive sleep apnoea on a sleep study
- People who cannot tolerate or prefer not to use CPAP
- People whose jaw shape – such as a small or set-back lower jaw – contributes to a narrow airway
Recovery
Most people take a few weeks to get used to a splint, with some jaw ache or extra saliva at first. After jaw advancement surgery, expect one or two nights in hospital, a soft diet for about six weeks and two to four weeks off work.
What is involved
Sleep apnoea is first diagnosed and graded with a sleep study, usually arranged by a sleep service. Will then assesses your jaws, teeth and airway, sometimes with scans or a camera examination of the airway, and discusses which option suits you.
Mandibular advancement splints
A custom-made splint, similar to a gum shield on the upper and lower teeth, holds the lower jaw slightly forward during sleep to keep the airway open.
- Made from impressions or a digital scan of your teeth
- Adjusted gradually until symptoms improve without discomfort
- Needs enough healthy teeth and healthy gums to hold the splint
- Its effect is usually checked with a repeat sleep study
Jaw advancement surgery (maxillomandibular advancement)
A form of orthognathic surgery in which both jaws are moved forwards, enlarging the airway behind the tongue and soft palate.
- Considered for selected patients after assessment with the sleep team, usually when CPAP and splints have not worked
- Planned in 3D and carried out under general anaesthetic from inside the mouth
- Can also improve the bite and facial balance where these are affected
- A sleep study after recovery checks the result
Risks and side effects
All surgery carries some risk. The main ones for this treatment are listed below; your own risk depends on your health and the details of your operation.
- Splints: jaw or tooth discomfort, dry mouth or excess saliva, and gradual changes to the bite with long-term use
- Surgery: numbness of the lower lip and chin, common at first and persistent in a minority
- Surgery: change in facial appearance, with the lips and nose looking more prominent
- Surgery: bleeding, infection, bite changes, plate removal or relapse
Alternatives
CPAP – a mask that gently blows air to keep the airway open – is the most effective treatment for moderate and severe sleep apnoea. Losing weight, avoiding alcohol before bed, sleeping on your side and treating a blocked nose can all help. Other airway surgery may be offered by ENT colleagues.
Trusted resources
- NHS: sleep apnoeaSymptoms, diagnosis and treatment
- Sleep apnoea and drivingDVLA guidance on when to tell them
Guidance and standards
NICE guideline NG202 (2021) recommends CPAP as the main treatment for symptomatic sleep apnoea, with a customised mandibular advancement splint as an alternative for people who cannot tolerate or decline CPAP, provided their teeth and gums are healthy. If sleep apnoea makes you excessively sleepy, you may need to tell the DVLA and stop driving until symptoms are controlled – see the gov.uk guidance.
Questions worth asking at your appointment
- Benefits – what will this treatment do for me?
- Risks – what could go wrong, and how likely is it for me?
- Alternatives – what other options are there?
- Nothing – what happens if I wait, or decide not to have treatment?
Based on the Choosing Wisely UK BRAN questions.