Sleep apnea surgery: types, risks and outlook


Surgery can help improve some cases of obstructive sleep apnea by removing or reducing the obstruction.

Sleep apnea is a common condition. Several potential treatment options can help, including surgical procedures. Surgery can reduce the obstruction that prevents the person from breathing while sleeping.

This article reviews what sleep apnea is and several of the surgical procedures that can help improve the condition.

Sleep apnea occurs when a person’s breathing stops and starts several times during sleep. It is a common condition that can prevent the body from getting enough oxygen.

The two types of sleep apnea are:

  • Central sleep apnea (CSA): It happens when the brain fails to send signals to the lungs to breathe. It often results from underlying health conditions that affect the brain.
  • Obstructive sleep apnea (OSA): This is the most common type where the airways become blocked periodically due to factors such as hormones, enlarged tonsils, or obesity.

Learn more about the types of sleep apnea here.

A doctor can diagnose sleep apnea with a sleep diary or a sleep study called polysomnography. During polysomnography, a healthcare professional connects a person to equipment that measures their breathing and other functions.

Doctors use the results to rule out other sleep disorders before diagnosing sleep apnea.

Learn more about polysomnography here.

Surgery is usually not an option for people with central sleep apnea, and doctors only recommend it for people with mild to moderate OSA.

However, researchers reported promising results using a “fully implantable unilateral transvenous phrenic nerve stimulation device” to improve symptoms of central sleep apnea. Research on this treatment is ongoing.

Doctors can sometimes treat obstructive sleep apnea with surgery. A surgeon must know the exact cause of the condition in order to perform any of the following types of surgery:

Nasal surgery

Nasal surgery can help reduce airway obstructions in the nose. Sleep apnea can occur if there is a blockage in any of the following parts of the nose:

  • nasal valve
  • septum
  • cones

The most common nasal surgeries to treat sleep apnea are septoplasty and turbinate reduction. These outpatient procedures are generally safe. They can improve sleep apnea symptoms by widening the septum or turbinates to allow air to flow freely through them.

Palate surgery

For mild cases of sleep apnea, a doctor may recommend soft palate surgery, also known as a pillar procedure. This outpatient procedure involves placing three plastic rods into the soft palate tissue.

The rods stimulate an inflammatory response in the tissue, which helps stiffen it. When this happens, the firm palate tissue is less likely to rub against the pharynx, which can help improve sleep apnea and snoring.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is the most common surgical procedure performed for sleep apnea. During the procedure, a surgeon removes excess tissue from the pharynx and soft palate as well as the tonsils if present. They then close the incisions.

The treated area is known as the oropharynx and is responsible for the majority of cases of sleep apnea.

The procedure requires an overnight hospital stay and can involve a painful recovery.

Removal of adenoids or tonsils

For children with sleep apnea, doctors often recommend adenotonsillectomy. In this procedure, the surgeon removes the adenoids and tonsils. Removing these structures can open the airways and improve sleep apnea.

According to a study 2016, children who are not obese and who have smaller tonsils may find that recovery and risk are lower if only the adenoids are removed. However, if the tonsils are larger, surgery may not be as effective as removing both.

Skeletal surgery

If a maxillofacial skeletal malformation has occurred, a doctor may recommend skeletal surgery to correct the problem. The procedure involves widening the jawbone by about 10 to 12 millimeters (mm) and then stabilizing it with titanium plates.

The procedure is relatively complicated compared to other surgeries due to the need to precisely cut the bone and properly align the teeth. As part of their recovery, the person will have to close their teeth and spend several nights in the hospital.

However, the procedure has a success rate of almost 90%, although few surgeons or institutions perform this surgery due to the complication of the procedure and the recovery.

Tongue surgery

There are two different procedures involving the tongue. They understand:

  • Language advancement: In this procedure, a surgeon moves the main muscle of the tongue (genioglossus muscle) forward. They make an incision in the jawbone, push it forward, then use a titanium plate to hold it in place. Although generally effective, it requires an overnight stay and is more invasive than other procedures.
  • Reduction of the base of the tongue: Tongue base reduction is a procedure that decreases the amount of tissue in the base of the tongue. A surgeon can do this either with an incision or using radiofrequency waves. Incision surgery (midline glossectomy) is more invasive and requires overnight hospitalization. The radiofrequency method is non-invasive but requires several sessions. Both can improve, but not necessarily cure, mild sleep apnea in about 60% of people.

Tracheotomy

In obese people, a tracheostomy can provide effective relief from sleep apnea. The procedure involves creating an opening in the trachea through the neck to allow oxygen to directly access the lungs. Doctors sometimes recommend it to people who have tried other treatments without success.

All surgical procedures have some risks associated with them. A person should speak with a doctor about the risks associated with the treatment option they are recommending.

Any procedure that requires general anesthesia puts a person at increased risk. This is due to its effects on breathing, which can make regaining consciousness more difficult. It can also make it harder for a person to breathe after the procedure.

Doctors will watch a person closely during surgery to prevent risks from general anesthesia.

Other general risks of surgery include:

Learn more about general anesthesia here.

Below are answers to some frequently asked questions about sleep apnea surgery.

Does surgery cure sleep apnea?

For some, surgery can cure or stop sleep apnea. Although many surgeries have high success rates, no single procedure can guarantee a cure for sleep apnea.

Are there other treatments for sleep apnea?

The first-line treatment for sleep apnea is continuous positive airway pressure (CPAP). CPAP involves a person wearing a mask over their mouth and nose which is connected to a machine. The machine delivers a constant flow of air to a person’s airways to help keep them open.

Doctors rarely recommend surgery to treat sleep apnea. A person can improve their sleep apnea if: manners:

  • make lifestyle changes, such as maintaining a healthy weight, limiting alcohol intake, quitting smoking, staying active, and eating a healthy diet
  • using oral devices to open the mouth more widely
  • do exercises for the mouth and jaw

A person should speak with a doctor about their expectations after the procedure. Most procedures have a high level of success, but not everyone will see improvement after surgery.

If surgery doesn’t work, a person’s doctor will likely recommend additional treatments.

Several surgeries can help improve sleep apnea. Some are minimally invasive outpatient procedures, while others require a hospital stay.

The surgery recommended by a doctor will vary depending on the underlying cause of the sleep apnea. A person should discuss their options with a doctor and ask about the chances of success.

The most common surgeries for sleep apnea are generally safe. Surgery that requires general anesthesia is associated with higher risks.

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