It's unknown how much of the cognitive deficits seen in OSA are reversible or not, and obviously in any given individual we really can't predict. It will become more clear with treatment. Basically you treat and see what's left. I personally wouldn't make the strong statements others have made that it will all be reversed. But there's a good chance, so let's keep a good thought.
About the tonsils... Unless you're in California, this is a toughie. What you want is someone who knows about doing a tonsillectomy for the purposes of widening the airway. A "lateral pharynogplasty", is a method of suturing the tonsil incision so that when it heals it retracts laterally and opens the airway. A general ENT who just removes tonsils for tonsillitis reasons is not likely to know about this. Furthermore, in my experience there are those who think they know what a lateral pharyngoplasty is, but either they aren't talking about the same thing others are, or no one can agree on this. Here is a link explaining it:
http://www.sleepapneasurgery.com/pharyngoplasty.html
When you talk about the jaw surgery, you're talking about an MMA, and you can read about it on the same site, here:
http://www.sleepapneasurgery.com/maxill ... ement.html
Personally I would try CPAP first, and a tonsillectomy if it's indicated, as well as weight loss, long before I'd ever consider an MMA.
As far as the 80 things that they check for during a sleep study, I assume Night Monkey was exaggerating. There are things that would show up, but they aren't running TSHs and things like that during a sleep study. I see no reason not to pursue routine screening for obvious things while working on CPAP therapy.
My own sleepiness may have caused me to miss this information, but is he CPAP compliant now? That is going to be the fastest way to returning him to baseline functioning.
You seem like a very caring person. I hear that you feel that if the man is "incompetent" by virtue of OSA than you have to stand by him, but if he's just a disorganized and incompetent guy, you might not feel the same level of commitment. I know everyone is going to jump on me for saying this, but... In my opinion, he's not your child (and in fact he's not even your spouse), so I don't think you need to feel that you must stay with him even if we could prove that he's incompetent by virtue of OSA. You were looking for a partner, not a child. I think you'll feel better about your role if you feel it's a choice to be with him (one that you can rethink at a later date), rather than thinking that you must stay with him because the poor guy loves you and can't help that he has OSA and what kind of person leaves a guy like that... Whether impaired by virtue of OSA, ADHD, low IQ, poor parenting, bad peer models, or anything else you can think of, it's not your fault and you shouldn't have to give up your dreams of having a partner because you stumbled into this. If you love the guy and want to give him a chance to improve his life with your help, that's great. Give him a chance and see what happens. You can always reassess later. Personally I'd make my staying contingent on his active pursuit of treatment. But that's just me. My tolerance for lack of cooperation with treatment would be very low if I were working as hard as you are. In short, he must be as committed to improving his life as you are committed to helping him do so.
That's my two cents.
P.S. Just read your post. He absolutely should be tested for allergies. Allergies can exacerbate this. It would not cause an AHI in the severe range, as far as I know, but it could certainly make things worse and make tolerance of CPAP more difficult.
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly
