If you suffer from obstructive sleep apnea (OSA) and haven’t been able to tolerate positive airway pressure (such as CPAP, BiPAP, or APAP), you may want to consider sleep apnea surgery. Various types of surgery for sleep apnea are designed either to help you tolerate positive airway pressure more easily or to treat your obstructive sleep apnea by itself. Learn more about sleep apnea surgeries and which might be best for you.
Of the many reasons that you may have trouble sleeping comfortably wearing a CPAP, two are narrow nasal passages (often causing nasal obstruction or congestion) and high CPAP pressures.
CPAP equipment can be difficult to wear if you have narrow nasal passages because the therapy is often delivered through the nose. In these cases, opening the nasal passages, which can be done with medications or surgery, has been shown to improve the ability of patients to use CPAP.
The most common nasal surgical procedure involves septoplasty and turbinate reduction. This sleep apnea surgery consists of an outpatient procedure that straightens out the septum and reduces the size of the turbinates (long, narrow passageways). This allows for more room in the nose which lets air pass smoothly and without effort.
You may require high CPAP pressures to treat your sleep apnea problems. While this is meant to be a treatment for sleep apnea, issues may arise related to the high pressure. One of the most common side effects is difficulty exhaling against the pressure.
Blocked nasal passages and enlarged tonsils or adenoids are two possible reasons why you may be having a negative experience with CPAP pressures. If this is something you struggle with, consider these treatments for sleep apnea.
All of these procedures relating to the nose, tonsils, and adenoids can potentially help you tolerate CPAP therapy. The goal of these surgeries is to make CPAP as comfortable as possible.
If you are unable to sleep comfortably using CPAP in spite of your best efforts, obstructive sleep apnea surgery may be an option. Before diving into details concerning surgery for sleep apnea, there are three important considerations you should know. One, not all surgeries are the same. Two, sleep apnea patients should only consider procedures that are well-suited to them. Three, not everyone is a good candidate for surgery.
Treatments for sleep apnea that directly target obstructive sleep apnea address blockage of breathing in the throat, either in the area behind the soft palate (roof of the mouth) or behind the tongue and epiglottis. Procedures can be broadly classified by the area of the throat (or, in some cases, the specific body structure) that they treat. These procedures can either be performed alone or, if you are thought to have blockage in more than one area of the throat, in combination.
This category of sleep apnea surgeries includes uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty, lateral pharyngoplasty, uvulopalatal flap, the pillar procedure, palatal advancement pharyngoplasty, z-palatoplasty, and relocation pharyngoplasty.
In general, these procedures involve removing the tonsils (if they have not been removed previously) and removing or repositioning of the soft palate, uvula, and soft tissues next to the palate and tonsils on the side of the throat. While each surgery for sleep apnea has its own complex process, here is a quick summary of each.
Hypopharyngeal procedures treat the area of the throat behind the tongue and epiglottis, which has been called the hypopharyngeal, retrolingual, or retroglossal region. This group of procedures includes tongue radiofrequency, genioglossus advancement, tongue stabilization, partial glossectomy, and hyoid suspension. These procedures either shrink, tighten, or reposition tissues that surround the lower portion of the throat. Here is a description of each.
As if there weren’t enough treatments for sleep apnea already, there are more surgeries available to you if you are a prime candidate.
Inspire upper airway stimulation is a new and exciting OSA surgery that involves placing a medical device inside the body so that it can function somewhat like a pacemaker for the tongue during sleep. The system is controlled by a small remote device that you can turn on and off yourself. The surgery is done under general anesthesia, but most patients are able to go home as quick as the next day.
This surgery for sleep apnea, also known as maxillomandibular advancement or bimaxillary advancement, is another surgical option. This procedure treats sleep apnea by moving the upper and lower jaws forward. It enlarges the space for breathing in the throat because the structures that surround the throat are effectively attached to the jaws. Advancing the jaws moves these structures forward, reducing their ability to produce blockage in the throat.
Maxillomandibular advancement surgery has demonstrated better results than the procedures listed above, but this procedure has more substantial risks and a longer recovery time.
Just as there are potential risks for any other type of invasive surgery, there are risks for patients who undergo OSA surgery. These risks fall into two categories: risks of health complications and risks specific to individual procedures.
The risks of serious health complications have been studied best for soft palate surgery. Results have shown that the risk is estimated at 1.2% (1/80). A key factor to remember is that people are much more likely to have these complications if they had significant medical problems before surgery (which is also true for other surgeries).
Before choosing a sleep apnea surgery, it is crucial to consult with your doctor and go through a thorough medical examination in order to make sure you are healthy enough to handle surgery. If you struggle with one or more serious health issues, you may not be a good candidate for OSA surgery.
Because these procedures treat structures of the throat, there are potential procedure-specific complications including troubles with swallowing, speech, taste, and tongue numbness or weakness.
There is also controversy about results of sleep apnea surgery. As with other surgeries, there isn’t a guarantee that you will experience a permanent fix to your problem. With OSA surgery, different patients experience different results and it really depends on a variety of factors. However, certain surgeries have been found to be more successful than others.
Research and consult with your doctor about the best course of action for you and your case of sleep apnea.
Overall, there are countless sleep apnea surgeries available to people struggling with obstructive sleep apnea. If traditional methods like CPAP and BiPAP haven’t worked for you, it may be time to consider one of the surgeries listed above. As always, make an appointment with your doctor to discuss the options that may work for you.
NOTE: Inspire and Upper Airway Stimulation are trademarks of Inspire Medical Systems, who is not affiliated with this website.
Author: Eric Kezirian, MD, MPH
© 2020 American Sleep Association.