What causes Obstructive Sleep Apnea (OSA)?
Obstructive Sleep Apnea happens when the upper airway becomes too narrow or collapses during sleep. This makes it hard to get enough oxygen and often causes repeated awakenings at night. The main reason for this problem is usually structural — meaning the shape or size of the airway isn’t wide enough to stay open during sleep.
Which parts of the airway are most affected?
The airway has different sections that can narrow or collapse. These include the nasopharynx (behind the nose), the velopharynx (around the soft palate and uvula), the oropharynx (behind the tongue, often the weakest point in adults), and the hypopharynx (below the tongue, influenced by tongue and neck position). If any of these areas are too small, it can block airflow and trigger OSA symptoms.
How can airway space be improved?
Research shows that the airway becomes most stable when it is widened side-to-side rather than front-to-back. Expanding the airway this way helps prevent collapse and allows smoother breathing during sleep. That’s why treatments that target the structure of the airway itself, instead of just masking symptoms, are more effective in the long term.
What is unique about Dr. Koval’s MARPEFACE protocol?
This is where Dr. Koval’s approach stands out. The MARPEFACE protocol uses custom-designed skeletal expanders (MARPE devices) followed by orthodontic treatment. Unlike traditional methods, which were only used for patients with crossbites, Dr. Koval’s research proved that midfacial skeletal expansion can help many adults with OSA or Upper Airway Restriction Syndrome (UARS), even without crossbites. What makes her protocol unique is that it is personalized: she adapts the expander design and orthodontic sequence to each patient’s airway shape, bite, and facial structure. This tailored approach addresses the root cause of airway constriction instead of using a one-size-fits-all solution.
What results can patients expect?
Patients treated with the MARPEFACE protocol often report dramatic improvements. Symptoms like frequent nighttime awakenings, restless or interrupted sleep, frequent urination at night, daytime fatigue, and sleepiness are greatly reduced. By combining skeletal expansion with individualized orthodontic treatment, Dr. Koval’s protocol doesn’t just increase airway volume — it gives patients a lasting, customized solution for healthier breathing and better sleep.
Dr. Koval’s MARPEFACE protocol is a breakthrough approach to treating Obstructive Sleep Apnea and Upper Airway Restriction Syndrome (UARS). Unlike traditional methods, which mainly used jaw expansion for crossbite cases, her research shows that midfacial skeletal expansion can benefit many adults with airway problems even without crossbites. What makes the MARPEFACE protocol unique is its personalized design — each patient receives a custom expander and orthodontic plan tailored to their airway shape, bite, and facial structure. By addressing the root cause of airway constriction, this protocol improves breathing, reduces sleep-related symptoms, and provides long-lasting results.