Obstructive Sleep Apnea & Surgery
Treating OSA Symptoms with uvulopalatopharyngoplasty (UPPP)
Obstructive sleep apnea surgery can alleviate snoring and OSA symptoms. Surgical options for sleep apnea are usually only suggested if CPAP treatment fails.
Obstructive sleep apnea (OSA) can be treated with surgery. Generally speaking, OSA surgery is not the first treatment choice for OSA, as other sleep apnea treatments are less invasive and often more effective.
Candidates for OSA Surgery
Not everyone is a candidate for OSA surgery. You may be a candidate for surgical sleep apnea treatment if your sleep study indicates an apnea index of twenty or more (twenty or more apnea events in one hour of sleep). Many sleep physicians only recommend sleep apnea surgery if CPAP machines either cannot be tolerated by the sleeper or prove ineffective.
Sleep Apnea Surgery Contraindications
Anatomical features of your tongue, mouth, and throat may preclude the possibility of sleep apnea surgery. Most OSA surgery requires general anesthetic, which is always a concern when any surgery is performed on patients with sleep apnea. Your response to anesthetic may also determine whether or not you are a candidate for OSA surgery.
Uvulopalatopharyngoplasty
Uvulopalatopharyngoplasty (UPPP) is the most common surgical treatment for snoring and sleep apnea symptoms. During an uvulopalatopharyngoplasty the surgeon removes the uvula (the fleshy "glob" of tissue that hangs at the back of the throat). During a UPPP the surgeon may also remove the tonsils, the adenoids, and part of the soft palate (the roof of the mouth at the back of the mouth). The intent of an uvulopalatopharyngoplasty is to widen the airway and lower the frequency of airway collapse during sleep.
UPPP surgery does not guarantee all sleep apnea symptoms will vanish. Limited studies suggest between forty to sixty percent of sleep apnea cases improve after uvulopalatopharyngoplasty surgery, but no definitive research has yet been performed on UPPP success rates.
Snoring may diminish after UPPP surgery, but only a sleep study will determine if the surgery has really reduced sleep apnea symptoms. Even with a successful uvulopalatopharyngoplasty you may still need to use a CPAP machine or OSA dental device.
Laser-Assisted Uvulopalatopharyngoplasty
Laser-assisted uvulopalatopharyngoplasty (LAUP), as the name implies, uses a laser to remove the uvula. LAUP is primarily used to treat snoring, and is beginning to be used to treat mild cases of sleep apnea.
Tonsillectomy, Pillar and other OSA Surgery Options
In addition to uvulopalatopharyngoplasty a number of other surgical options are available for OSA sufferers. Tonsillectomy to remove enlarged tonsils is often performed on children with sleep apnea, as enlarged tonsils are the most common cause of pediatric sleep apnea. Adenoidectomy, or the removal of enlarged adenoids, may also improve OSA symptoms and snoring in some people.
Other types of obstructive sleep apnea surgery may reshape the jaw or remove a portion of the tongue. Somnoplasty was approved for use as a sleep apnea treatment in 1998. Somnoplasty uses high frequency radio waves to shrink the tongue and the soft palate.
Mild to moderate sleep apnea symptoms may improve with the Pillar procedure. Also known as palatal implants, the Pillar procedure inserts three palatal implants into the soft palate. The palatal implants reduce soft palate vibrations, which in turn reduces the severity of snoring and sleep apnea.
Tracheotomy and Sleep Apnea
One of the most effective sleep apnea surgical procedures is also one of the most drastic. A tracheotomy creates a hole in the windpipe and through the throat. As the tracheotomy is below the site of airway obstructions, sleep apnea symptoms are essentially cured.
Most people shy away from the idea of a permanent hole in their throat, and physicians usually only suggest a tracheotomy for severe OSA cases when other forms of sleep apnea treatment have failed.
Sleep Apnea Surgery Complications
Bleeding and infection are possible OSA surgery complications, and surgery sites are very painful in the weeks following surgery. Surgery involving the tongue can sometimes affect taste sensations.
The pulmonary airways may swell after surgery, causing difficulty breathing and respiratory distress (for this reason most sleep apnea surgery patients have postoperative overnight stays in hospitals, for observation and, if needed, prompt intervention).
Disclaimer: The information contained within this article is for informational purposes only, and is not intended to be a substitute in any way for care and treatment by a qualified health professional.
Resources
American Sleep Apnea Association. (n.d.). Considering Surgery for OSA?
Lindman, J., MD (updated 27 April 2007). Snoring and Obstructive Sleep Apnea, Surgery.
Quiet Sleep. (updated 19 January 2008). Surgery.
WebMd. (updated 13 July 2007). Sleep Apnea: Surgery.
