Sleep apnea is a common disorder characterized by repeated interruptions in breathing during sleep, preventing restorative rest. The two primary forms are Obstructive Sleep Apnea (OSA), caused by a physical collapse of the upper airway, and the much less common Central Sleep Apnea (CSA), which occurs when the brain fails to send the correct signals to the breathing muscles. The complexity of both conditions requires a coordinated team of medical specialists for accurate diagnosis and effective management.
Sleep Medicine Specialists
Sleep Medicine Specialists, often Pulmonologists or Neurologists, serve as the primary diagnosticians and managers of sleep apnea. These physicians complete extensive fellowship training to gain board certification in sleep medicine, providing a deep understanding of sleep physiology and breathing disorders. They typically order and interpret a polysomnography, the comprehensive overnight sleep study used to confirm the diagnosis and determine the severity of the apnea-hypopnea index (AHI).
The most common treatment prescribed is Continuous Positive Airway Pressure (CPAP) therapy. This device delivers pressurized air through a mask to mechanically hold the airway open during sleep, preventing the collapse characteristic of OSA. Specialists also manage other respiratory devices, such as Bi-level Positive Airway Pressure (BiPAP) or Adaptive Servo-Ventilation (ASV), often reserved for patients with complicated breathing patterns like those seen in CSA. The specialist monitors treatment adherence and adjusts pressure settings to ensure optimal patient outcomes.
Surgeons Who Address Airway Structure
Surgeons specializing in airway structure become involved when sleep apnea is caused by anatomical obstructions or when patients cannot tolerate non-invasive therapies. Otolaryngologists (ENT specialists) assess and treat issues within the nasal passages, soft palate, and throat. They may perform procedures like tonsillectomy, adenoidectomy, or Uvulopalatopharyngoplasty (UPPP) to remove excess soft tissue blocking the airway.
Maxillofacial Surgeons focus on structural issues related to the jaw and facial skeleton. They may recommend Maxillomandibular Advancement (MMA), a procedure that surgically moves the upper and lower jaws forward to physically enlarge the entire upper airway. Another surgical option is hypoglossal nerve stimulation, which involves implanting a device to electrically stimulate the nerve controlling the tongue, keeping the airway open during sleep. These interventions require careful evaluation to ensure the patient’s anatomy will benefit from the procedure.
Dental Sleep Medicine Practitioners
Dentists with specialized training in Dental Sleep Medicine offer a non-surgical treatment path for many patients. These practitioners focus on Oral Appliance Therapy (OAT), which uses custom-fitted mandibular advancement devices (MADs). The appliance is worn at night and gently shifts the lower jaw and tongue forward, stabilizing and keeping the upper airway open.
Oral appliances are an effective first-line treatment for patients with mild to moderate OSA. They are also a utilized alternative for patients with severe OSA who cannot consistently use or tolerate a CPAP machine. The dental practitioner works in collaboration with the primary sleep physician, who provides the official diagnosis and prescription necessary for the fabrication and ongoing adjustment of the oral appliance.
Navigating the Treatment Team
The journey to diagnosis and treatment often begins with the Primary Care Physician (PCP). The PCP is trained to recognize the common symptoms and risk factors associated with sleep apnea, conducting an initial screening and physical exam. If sleep apnea is suspected, they initiate the referral process to a specialist for diagnostic testing. The PCP plays a continuous role in managing the patient’s overall health and addressing comorbidities like hypertension or diabetes that are often worsened by untreated sleep apnea.
The formal diagnosis is made possible by the Sleep Technologist, who administers the overnight sleep study in a lab or sets up a home sleep apnea test. These technologists monitor brain activity, breathing patterns, and oxygen levels to collect the data the sleep specialist interprets. For patients with complex underlying conditions, coordination may be necessary with specialists like a Cardiologist for heart-related issues or an Endocrinologist for diabetes management, ensuring all health aspects are addressed concurrently with the sleep disorder.