Sleep and Breathe Wellness Center

Sleep-disordered breathing (SDB) can affect patients across the lifespan, from very young children to adolescents, adults, and older patients. It may appear differently depending on sex, growth stage, medical history, and prior treatment.

In young children, symptoms include snoring, mouth breathing, restless sleep, bedwetting, mood changes, attention deficit, and growth delay. In adolescents, sleep-disordered breathing contributes to fatigue, poor concentration, mood changes, non-restorative sleep, and challenges with academic or athletic performance.

In adults, symptoms include snoring, witnessed pauses in breathing, gasping or choking during sleep, morning headaches, daytime fatigue, poor sleep quality, difficulty concentrating, high blood pressure, metabolic syndrome, and increased risk of motor vehicle accidents.

Premenopausal women present differently than men, with fatigue, insomnia, poor sleep quality, and mood changes, in the setting of upper airway resistance symptoms. Symptoms can be severe even when the diagnosis is only mild sleep apnea.

Chang CP, Dierks E, Cheng A, Ma Y, Liu SY. Does the lack of gender-specific apnea-hypopnea index cutoff for obstructive sleep apnea impact surgical selection? J Oral Maxillofac Surg. 2021;79(3):666-671.

Dr. Stanley Liu evaluates breathing during sleep through his combined medical training, dental and orthodontic insight, and sleep surgery with maxillofacial surgery experience. This integrated perspective allows the Center to guide patients toward individualized care pathways.

The NSU Health Sleep and Breathe Wellness Center in Fort Lauderdale provides advanced evaluation and individualized care for patients with obstructive sleep apnea, sleep-disordered breathing, CPAP intolerance, upper airway resistance symptoms, and complex breathing concerns during sleep.

Clinical services may include evaluation, treatment planning, and procedure-based care pathways such as:

• Comprehensive sleep and breathing evaluation
• Review of sleep studies, imaging, medical history, and treatment history
• Evaluation of CPAP and oral appliance therapy (mandibular advancement device) intolerance or incomplete response
• Nasal and upper airway examination
• Maxillofacial evaluation
• Upper airway and sleep surgery consultation
• Maxillofacial sleep surgery evaluation and treatment planning
• Maxillary expansion (DOME) evaluation and care pathway for pediatric and adult patients
• Maxillomandibular Advancement (MMA) evaluation and surgical care pathway
• Sleep (sedation) endoscopy (DISE) when clinically appropriate
• Hypoglossal nerve stimulation (Inspire) evaluation and surgical care pathway for appropriate candidates
• Oral appliance and orthodontic collaboration when appropriate
• Pediatric and adolescent sleep and breathing assessment
• Coordination with sleep medicine, dentistry, imaging, and myofunctional therapy

Dr. Stanley Liu’s care pathways integrate advanced diagnostic evaluation, sleep surgery, maxillofacial sleep surgery, and multidisciplinary collaboration to determine whether a patient may benefit from non-surgical management, collaborative care, sleep endoscopy, DOME, or surgical procedures such as nasal surgeries, MMA, Inspire, and other individualized treatment options.

• Director, NSU Health Sleep and Breathe Wellness Center
• Associate Professor, Oral and Maxillofacial Surgery, Nova Southeastern University
• Former Assistant Dean of Hospital Affairs and former Chair, Oral and Maxillofacial Surgery, Nova Southeastern University
• Former Director, Stanford Sleep Surgery Fellowship, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine
• Lead author of the Updated Stanford Sleep Surgery Algorithm and co-author with Riley and Powell of multiple sleep surgery book chapters
• Pioneer of the DOME procedure and its ongoing development
• Deputy President, Global Initiative for OSA
• Keynote Speaker, World Sleep Congress (2023) and APSS Annual Meeting (2019)
• Author of 120+ peer-reviewed publications, book chapters, consensus statements, and clinical protocols across soft-tissue sleep surgery, skeletal and maxillofacial sleep surgery, hypoglossal nerve stimulation, and pediatric sleep apnea.
• First to describe MMA success based on DISE observations. First to perform hypoglossal nerve stimulation (Inspire) after MMA in sequence.

Dr. Stanley Liu has updated the Riley-Powell-Liu Stanford Sleep Surgery Protocol, building on the original Riley-Powell framework and moving sleep surgery toward a phenotype-based approach. His work integrates patient selection, sleep endoscopy, preservation pharyngoplasty, upper airway stimulation (Inspire), MMA, DOME, multimodal treatment planning, and long-term management for obstructive sleep apnea and sleep-disordered breathing.

Liu SYC, Riley RW, Yu MS. Surgical Algorithm for Obstructive Sleep Apnea: An Update. Clin Exp Otorhinolaryngol. 2020;13(3):215-224. Liu SYC, Awad M, Riley RW, Capasso R. The Role of the Revised Stanford Protocol in Today’s Precision Medicine. Sleep Med Clin. 2019;14(1):99-107.

Dr. Stanley Liu’s work on DOME, or Distraction Osteogenesis Maxillary Expansion, has helped advance maxillary expansion as a sleep and breathing treatment option for selected patients with obstructive sleep apnea, narrow maxillary structure, nasal breathing limitation, and sleep-disordered breathing. This work connects the maxilla, nasal floor, nasal breathing, orthodontics, and sleep surgery into a broader naso-maxillary framework, with age-appropriate expansion strategies spanning pediatric growth modification, adolescent care, and adult DOME treatment.

Liu SYC, Guilleminault C, Huon LK, Yoon A. Distraction Osteogenesis Maxillary Expansion (DOME) for Adult Obstructive Sleep Apnea Patients with High Arched Palate. Otolaryngol Head Neck Surg. 2017;157(2):345-348. Liu SYC, et al. How does DOME improve obstructive sleep apnea? Computational fluid dynamics analysis. 2020.

Dr. Stanley Liu’s research has explored emerging diagnostic and computational tools such as ultrasound tongue imaging, deep learning, computational fluid dynamics, imaging analysis, and AI-driven approaches to better understand upper airway anatomy, function, airflow, and sleep-disordered breathing. This innovation area supports more precise diagnosis, surgical planning, and future personalized sleep and breathing care.

Hanif U, Kiaer EK, Capasso R, Liu SY, Mignot EJM, Sorensen HBD, Jennum P. Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning. Sleep Med. 2023;102:19-29. Liu SYC, Bosschieter PFN, Abdelwahab M, Chao PY, Chen A, Kushida C. Association of Backscattered Ultrasonographic Imaging of the Tongue With Severity of Obstructive Sleep Apnea in Adults. 2023.

Dr. Stanley Liu has been developing research focused on perioperative safety, remote monitoring, and technology-supported care for oral and maxillofacial surgery patients. This work aims to improve patient safety, recovery, and continuity of care before and after procedures, while creating future opportunities for clinical research, philanthropy, and industry collaboration.

Optional collaboration line: For research, philanthropic, or industry collaboration related to perioperative safety and sleep and breathing innovation, please contact the Center.

Obstructive sleep apnea is part of a broader spectrum of sleep-disordered breathing. It occurs when the upper airway repeatedly narrows or collapses during sleep, affecting breathing, oxygen levels, sleep quality, daytime function, cardiovascular health, and overall quality of life. OSA can range from mild to severe, and its impact may differ from patient to patient. A careful evaluation helps determine not only whether OSA is present, but also why it is happening and which treatment options may be appropriate.

Common signs include snoring, witnessed pauses in breathing, gasping or choking during sleep, morning headaches, daytime fatigue, poor concentration, and non-restorative sleep. Diagnosis usually involves a sleep study, which reports the apnea-hypopnea index, or AHI, as one measure of breathing events during sleep. However, AHI is only one number. Some patients may have meaningful symptoms even when AHI appears mild, and women may present with insomnia, poor sleep quality, mood changes, or fatigue rather than classic sleepiness. A comprehensive evaluation should consider symptoms, sleep study findings, oxygen levels, breathing effort, anatomy, prior treatment response, patient preferences, and the pattern of airway collapse, so treatment can be individualized rather than based on a one-size-fits-all approach.

CPAP is an important first-line therapy, but some patients struggle to tolerate it or do not feel fully restored despite using it. At the NSU Health Sleep and Breathe Wellness Center, the next step is to understand why breathing remains disrupted during sleep and whether specific factors can be improved to make CPAP more tolerable or effective. Dr. Stanley Liu’s evaluation follows a sleep surgery algorithmic approach, looking at the patient’s symptoms, sleep study findings, airway anatomy, breathing pattern, prior treatment response, and personal goals. Based on this evaluation, some patients may be guided toward improving CPAP tolerance, while others may be candidates for advanced diagnostic evaluation or individualized sleep surgery options.

DOME stands for Distraction Osteogenesis Maxillary Expansion. It is a maxillary expansion approach used in selected patients with sleep-disordered breathing, narrow maxillary structure, and nasal breathing limitation. Because the maxilla forms part of the nasal floor, expansion can influence nasal breathing and sleep-related breathing function in appropriately selected patients. Dr. Stanley Liu’s work on DOME connects orthodontics, maxillofacial surgery, nasal breathing, and sleep surgery within a broader sleep and breathing framework, helping support more precise treatment sequencing and individualized surgical planning.

Coverage depends on the patient’s insurance plan, diagnosis, medical necessity, sleep study findings, prior treatment history, and the procedure being considered. Many sleep surgery procedures may be considered when symptoms, objective findings, and prior treatment response support medical necessity. The care team can help guide patients through evaluation, documentation, and authorization steps.

Yes. Sleep-disordered breathing can affect patients across the lifespan, including young children and adolescents. In younger patients, signs may include mouth breathing, restless sleep, snoring, behavioral changes, attention difficulties, growth concerns, dental crowding, narrow palate, or disrupted sleep quality. Evaluation may involve dental, orthodontic, medical, and surgical perspectives, with care individualized to the child’s age, growth stage, and breathing concerns.

Sleep endoscopy, also known as drug-induced sleep (sedation) endoscopy or DISE, allows the upper airway to be evaluated in a sleep-like state. It can help identify where and how the airway collapses during sleep, which is different from looking only at the airway while awake. This information can support more precise planning for patients considering sleep surgery, oral appliance therapy, hypoglossal nerve stimulation, DOME, MMA, or other individualized options.

The NSU Health Sleep and Breathe Wellness Center in Fort Lauderdale integrates medical, dental, upper airway, sleep surgery, and maxillofacial surgical expertise under the direction of Dr. Stanley Liu. This allows the Center to evaluate breathing during sleep through both functional and structural lenses. The goal is to guide each patient toward an individualized care plan.

MMA stands for maxillomandibular advancement. It is a procedure that moves the upper and lower jaws forward together to enlarge and stabilize the airway behind the palate and tongue, which can improve breathing during sleep. Because it addresses the skeletal framework of the airway rather than only the soft tissue, MMA is one of the most effective surgical options for selected patients with moderate-to-severe obstructive sleep apnea, including those who have not been fully helped by CPAP. Whether MMA is appropriate depends on a careful evaluation of symptoms, sleep study findings, airway anatomy, and prior treatment, which Dr. Stanley Liu reviews as part of an individualized care pathway.

Hypoglossal nerve stimulation (Inspire) is a small implanted device that gently stimulates the nerve controlling the tongue during sleep, helping keep the airway open with each breath. It is designed for selected patients with obstructive sleep apnea who cannot tolerate or are not fully helped by CPAP and who meet specific criteria. Sleep endoscopy (DISE) is often used first to confirm that the pattern of airway collapse is suitable. Dr. Stanley Liu evaluates whether Inspire or another individualized option best fits each patient’s anatomy, breathing pattern, and goals.