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Sleep Apnea Treatment Options for Adults in Kuwait

A growing number of people in the State of Kuwait are suffering from sleep apnea, a serious medical condition that requires proper diagnosis and treatment. What exactly is this condition, and how can it be managed?

Sleep apnea occurs when the upper airway becomes blocked during sleep. This obstruction partially awakens the patient so that breathing can resume. This cycle of blockage, waking, and returning to sleep repeats throughout the night, preventing the patient from getting restful, deep sleep. In addition to depriving the patient of quality sleep, this interruption reduces blood flow to vital organs, affecting overall health. If left untreated, it can increase the risk of several diseases, including insulin resistance (the beginning of diabetes) and cardiovascular diseases. Patients experience various symptoms, most notably: loud snoring, a feeling of choking, or others noticing pauses in breathing during sleep, frequent nighttime awakenings, not feeling rested after sleep, morning headaches, and excessive daytime sleepiness.

Certain factors increase the risk of developing sleep apnea, such as: obesity, post-menopause in women, being male, and advancing age. Additionally, certain facial and jaw structural features may increase the likelihood of the condition, such as: a small or receded lower jaw, a narrow upper jaw, and improper dental alignment (open bite).

Estimates suggest that approximately twenty percent of adults in Kuwait are at high risk for this condition. Sleep apnea is diagnosed through an overnight «sleep study,» which must be conducted under the supervision of a physician specializing in sleep medicine.

Dentists play an important role in recognizing the signs and symptoms indicative of the disease, taking the patient's medical history, and referring them to a sleep medicine specialist when needed. After diagnosis, the sleep physician determines the appropriate treatment. The most important treatment options include:

1. Positive Airway Pressure Device

This is considered the optimal treatment for sleep apnea. It consists of a mask connected to a machine that pumps air to keep the airway open during sleep. It is prescribed and provided by a sleep physician.

2. Mandibular Advancement Device

This is a device fitted in the mouth to be worn during sleep. The device pushes the lower jaw forward, which helps open the upper airway. This device is provided by an orthodontist or dentist and is prescribed for patients who cannot tolerate using the positive airway pressure device, or if the apnea is not severe, or for snoring. Research indicates that although this device is less effective than the previous one, patients tend to accept it better.

To manufacture a mandibular advancement device, I will begin by examining your teeth and mouth. After we determine that you are eligible for treatment with this device, I will take a digital impression of your teeth using a scanner. The device is then custom-designed for you in collaboration with a dental laboratory. Even after you start using the device, you will need to follow up with the treating physician to ensure its effectiveness and make any necessary adjustments. I may also ask you to revisit your sleep physician for a new sleep study to evaluate the effectiveness of the mandibular advancement device treatment.

3. Surgery

Patients who cannot use either of the two devices may opt for soft tissue surgeries of the pharynx and tongue stimulation with ear, nose, and throat surgeons, or jaw advancement surgery with oral and maxillofacial surgeons.

Patients we typically advise for jaw surgery usually suffer from severe apnea and also require orthodontic treatment. Maxillomandibular advancement surgery involves moving the upper and lower jaw bones forward, which in turn tightens the soft tissues of the throat and tongue, thereby widening the airway. Orthodontic treatment is essential to ensure the success of this surgery. Before the operation, orthodontics properly align the teeth to fit the new position of the jaws after surgery. After surgery, orthodontics continues to adjust the dental occlusion and improve alignment. Without orthodontic treatment, the desired outcomes of the surgery may not be achieved, and the patient may suffer from bite problems. Therefore, orthodontics is a fundamental part of ensuring long-term surgical success and improving both breathing and chewing function.

4. Upper Jaw Expansion

Patients with a narrow upper jaw need to have it expanded using implant-supported devices, which widens the nasal airway, improves breathing, and alleviates apnea symptoms. The orthodontist will take a cone-beam CT scan to assess the optimal placement for the small implants and design the device. After the design is approved by the doctor, the custom device will be manufactured in a specialized laboratory. Each device is individually designed according to each patient's needs to ensure the best possible results in upper jaw expansion. After the device is fitted, the orthodontist will explain how to operate it and how often to use it. It is very important to follow the instructions precisely to ensure the best results and minimize the chances of any side effects.

For clinical evaluation as a sleep apnea orthodontist in Kuwait, visit our airway orthodontics page.