Sleep Apnea in Barcelona
What Is Sleep Apnea?
The result is poor-quality, non-restorative sleep, as well as drowsiness and chronic daytime sleepiness. Furthermore, these episodes of apnea can lead to serious medical problems such as high blood pressure, an increased risk of heart attack, strokes, behavioral changes, irritability, sexual dysfunction, etc.
Our Methodology
At Clínica Birbe, we perform home polygraphy.
It involves recording a series of parameters at home—such as oxygen saturation, heart rate, airflow, snoring, and changes in position—during a sleep period of at least 5 hours. This study allows us to calculate the AHI (Apnea-Hypopnea Index per hour) and thus diagnose whether OSA is present and, if so, whether it is mild, moderate, or severe. We also routinely perform this study on any patient undergoing orthognathic surgery, as it can influence the movements that need to be performed.
Surgical Steps
If sleep apnea is confirmed, the patient has several options. The standard approach is to use CPAP. It is a device with a cumbersome mask that the patient puts on every day to sleep. Although effective, the device eventually becomes intolerable for the patient after a few months, which is why other treatments are being sought.
Mandibular advancement devices (MADs) can serve as an alternative to CPAP in some cases. But again, intolerances may develop over time, in addition to changes in tooth position and pain in the temporomandibular joint.
The only curative treatment for AOS available today is bimaxillary orthognathic surgery with mentoplasty. It involves maxillomandibular advancement with chin advancement, thereby increasing the diameter of the airway. In this way, the airway collapse that occurs during sleep in patients with OSA is prevented, as the airway area triples.
Furthermore, since patients with AOS often have a retrusive facial profile—characterized by a short neck, lack of projection in the middle and lower thirds of the face, and a reduced mentocervical distance—the movements achieved through orthognathic surgery yield very favorable aesthetic results.
Treatment Process
The surgical treatment of sleep apnea at Clínica Birbe follows a structured, multidisciplinary process, because the decision to operate is never made lightly or in isolation.
1. First visit and initial evaluation. Dr. Birbe reviews the polysomnography report provided by the patient (or requests one if it has not been performed), performs a complete facial examination, and assesses the skeletal pattern: the position of the maxilla, mandible, chin, neck, and airway. We also review previous treatments: whether you have used CPAP, how well you tolerated it, whether you have tried DAM, and what results you have obtained.
2. Advanced diagnostic workup. A CBCT (3D dental CT scan) is performed to assess the airway in three dimensions, along with a cephalometric radiograph and clinical photographs. When necessary, we coordinate with the patient’s pulmonologist or the patient’s designated sleep center to confirm the indication and rule out other causes.
3. Virtual surgical planning. Using all the data, a 3D plan is created for maxillomandibular advancement: how many millimeters to advance the maxilla and mandible, whether mentoplasty will be performed, and what the postoperative airway will look like. This planning is simulated before entering the operating room.
4. Pre-surgical orthodontics. In most cases, prior orthodontic treatment lasting between 6 and 18 months is required to align the dental arches and ensure that the jaws fit together properly after the advancement. He coordinates with the orthodontics team at the clinic in Barcelona.
5. Surgery. Maxillomandibular advancement is performed in a hospital operating room under general anesthesia and requires a 1- to 2-night hospital stay. It is a technically demanding surgical procedure, performed at Clínica Birbe by Dr. Birbe, the only oral and maxillofacial surgeon in Spain certified by the American Board of Oral and Maxillofacial Surgery (ABOMS).
6. Postoperative follow-up and confirmation of the results. Scheduled follow-up visits during the first year and a follow-up polysomnography to objectively confirm that the apnea has resolved.
Recovery time
Recovery following maxillomandibular advancement for sleep apnea is gradual and predictable, but it requires patience: we are altering the position of the facial bones, and that takes time to heal.
| Phase | Estimated timeframe | What to Expect |
|---|---|---|
| Hospital Admission | 1–2 nights | Pain management, continuous facial icing, cold liquid diet |
| First Week | Days 1–7 | Swelling peaks between the 3rd and 5th day; liquid diet; rest at home; sick leave |
| Weeks 2 and 3 | Days 8–21 | Significant reduction in inflammation; transition to a soft, pureed diet; resumption of light daily activities |
| 1st month | 30 days | Return to work in most cases (depending on the type of work); a soft, non-pureed diet |
| 2–3 months | 60–90 days | Gradual return to a normal diet; return to light exercise (walking, stationary bike) |
| 6 months | 180 days | Advanced bone healing, unrestricted sports participation, facial sensation nearly restored |
| 12 months | 1 year | Follow-up polygraphy to confirm resolution of apnea and assess the final aesthetic outcome |
Most patients notice a subjective improvement in sleep within the first few weeks, although the objective result is confirmed by a postoperative sleep study. It may take several months for sensitivity in the lower lip and chin to return to normal; we always explain this before surgery so it doesn’t come as a surprise.
Duration of treatment
The total duration of treatment depends primarily on the preceding orthodontic phase, not on the surgery itself.
| Phase | Approximate duration |
|---|---|
| Diagnostic Evaluation and Planning | 4–8 weeks |
| Pre-surgical Orthodontics | 6–18 months (depending on the complexity of the case) |
| Surgery (hospital admission) | 1–2 nights in the hospital |
| Post-surgical Orthodontic Finishing Treatment | 3–6 months |
| Follow-up and Monitoring Using Polygraphy | Up to 12 months after surgery |
| Overall Treatment | Approximately 12–24 months |
Dr. Joan Birbe: ABOMS certified specialist
Dr. Joan Birbe is the only oral and maxillofacial surgeon in Spain certified by the American Board of Oral and Maxillofacial Surgery (ABOMS), the leading international authority in oral and maxillofacial surgery and the body that sets the world’s highest standards in this specialty.
In sleep apnea surgery, that difference translates into something very specific: the criteria for making the correct diagnosis. The international literature recognizes maxillomandibular advancement as the only curative treatment, with success rates exceeding 95% in carefully selected patients; however, the opposite is also clear: performing surgery on an unsuitable candidate exposes them to major surgery with no guarantees. International consensus—which Dr. Birbe actively follows as part of the ABOMS continuing education program—currently positions surgery as the first-line treatment for certain patient profiles (severe apnea with retrusive anatomy, CPAP intolerance, contraindications for neurostimulation) and as a secondary treatment for others.
With more than 20 years of experience in orthognathic surgery in Barcelona, Dr. Birbe combines virtual airway planning, coordination with pulmonologists and leading sleep centers, and an approach that does not separate function from aesthetics: the procedure that cures sleep apnea is also the one that rejuvenates the profile, projects the chin, and opens up the eyes.
When a patient with severe sleep apnea comes to Clínica Birbe, they don’t just receive yet another opinion among those they’ve already heard—they receive an ABOMS diagnosis and a plan designed to permanently resolve their sleep apnea.
Why Choose Clínica Birbe for Surgery?
Sleep apnea surgery is neither cosmetic surgery nor conventional orthognathic surgery: it is a cardiovascular procedure that directly impacts the patient’s life expectancy and quality of life. That is why, at Clínica Birbe, we always approach it as a multidisciplinary process in which a maxillofacial surgeon, a pulmonologist, an orthodontist, and the sleep unit work together according to the same treatment plan.
In Barcelona, there are few centers that perform maxillomandibular advancement often enough to maintain an experienced team. The surgery is technically demanding—the upper jaw, lower jaw, and usually the chin are moved simultaneously, with the goal of tripling the airway area—and there is no room for improvisation. The learning curve takes its toll, and this is evident both in the functional outcome (objective resolution of apnea, confirmed by postoperative polysomnography) and in the aesthetic outcome (a harmonious facial profile).
We use 3D virtual planning specifically designed for sleep apnea: we measure the airway volume beforehand and simulate how it will look after the advancement, millimeter by millimeter. The patient understands what procedure will be performed and why before making a decision.
And, above all, we’re honest in our assessment: if your sleep apnea responds well to CPAP or MAS and your anatomy isn’t clearly retroversed, we’ll tell you so. If so, we offer a comprehensive plan with a fixed budget, financing, and follow-up through the follow-up polygraph test that objectively confirms the result.
Frequently Asked Questions: Sleep Apnea
How do I know if I'm a candidate for surgery or if I should continue using CPAP or DAM?
The indication for surgery depends not only on the severity of the apnea, but also on facial anatomy. CPAP and DAM are effective treatments, but they are palliative: they work as long as they are used every night, for the rest of one’s life. Maxillomandibular advancement surgery is considered when there is intolerance or poor adherence to these devices, when apnea is moderate or severe, or when there is a retrusive facial pattern (underprojected upper and lower jaws, receding chin, short neck). During the first visit to Clínica Birbe in Barcelona, Dr. Birbe evaluates the patient using a polygraph test, performs a cephalometric analysis, and conducts an airway examination to determine whether the cause of the apnea is anatomical and, therefore, amenable to definitive surgical correction. Not all patients with apnea are suitable candidates, and being honest about that selection process is part of the ABOMS criteria we follow.
Does surgery completely cure sleep apnea, or does it just improve it?
In appropriately selected candidates, maxillomandibular advancement is currently the only treatment intended to cure the condition. The scientific literature reports success rates exceeding 95% in patients with appropriate indications, with stable long-term results. This means that, after surgery, most patients no longer need CPAP or DAM and are able to get truly restful sleep again. The reason is mechanical: as the upper jaw and lower jaw (and usually the chin) move forward, the airway space is permanently widened, up to three times its original area. This is not a subjective improvement, but rather an anatomical change that can be measured using postoperative polygraphy. At Clínica Birbe, we always confirm the results with a new sleep study several months after the procedure. When we talk about “healing,” we base our discussion on objective data, not on perceptions.
What happens if I don't get treatment for my sleep apnea? Is it dangerous to wait?
Yes, and that’s one of the points we’re most concerned about conveying during consultations. Untreated sleep apnea is not just a problem of fatigue or snoring: it is a major cardiovascular and metabolic risk factor. Repeated drops in oxygen levels during the night are associated with resistant hypertension, arrhythmias, myocardial infarction, stroke, type 2 diabetes, cognitive decline, and an increased risk of traffic accidents due to daytime sleepiness. The longer the condition goes untreated, the more difficult it is to reverse the accumulated cardiovascular damage, even if surgery or CPAP therapy is used later. That’s why, when a patient comes to our clinic in Barcelona with a diagnosis of moderate or severe sleep apnea and has been putting off treatment for years, the message is clear: this isn’t about appearance or comfort—it’s about health. Decide calmly—yes; put it off indefinitely—no.
Does Social Security in Catalonia cover sleep apnea surgery?
Maxillomandibular advancement surgery for sleep apnea is covered under the National Health System’s portfolio of services—including CatSalut in Catalonia—when there is a documented medical indication (moderate or severe apnea, failure or intolerance to CPAP, favorable anatomy). In practice, however, waiting times are long, and very few public hospitals perform this type of surgery often enough to maintain an experienced team. In the private sector, some mutual insurance companies partially cover the procedure depending on the policy, while others do not include it because they consider it highly complex. At Clínica Birbe in Barcelona, we help each patient review their insurance policy, prepare the reports required by their health insurance provider or primary care physician, and understand exactly what each treatment option covers before making a financial decision. Transparency on this point is non-negotiable for us.
How does this surgery differ from UPPP or hypoglossal nerve stimulation?
These are techniques with very different objectives and outcomes. Uvulopalatopharyngoplasty (UPPP) targets the soft tissues of the throat (uvula, soft palate, tonsils); it can reduce snoring, but its effectiveness in treating moderate-to-severe sleep apnea is limited and difficult to predict over the long term. Hypoglossal nerve stimulation is a relatively recent option, indicated in very specific cases, that requires the implantation of a permanent device and is typically reserved for patients who cannot tolerate CPAP and are not candidates for skeletal surgery. Maxillomandibular advancement, on the other hand, addresses the anatomical cause of the obstruction: it widens the bony cavity that houses the airway—without implants, without external devices, and with a result that remains stable over time. For this reason, international consensus guidelines identify it as the treatment of choice for carefully selected patients. During the consultation, we always explain the three options and their pros and cons so that you can make an informed decision.
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