Sleep Apnea Surgery

What is Sleep Apnea Surgery?

Sleep apnea surgery refers to different types of surgeries performed to treat patients with sleep apnea, also referred to as obstructive sleep apnea (OSA).

Sleep apnea is a serious health condition characterized by recurrent episodes of stopping or slowing of breathing due to airway collapse. During these episodes, breathing reduces or stops and then resumes with a snort, gasp, or jerk. This can happen hundreds of times while you are asleep, decreasing your quality of sleep and making you feel tired during the day. Untreated sleep apnea can contribute to high blood pressure, heart disease, stroke, motor vehicle or workplace accidents, and considerable loss of productivity.

The different types of surgery for sleep apnea focus on eliminating blockages or obstructions in a patient’s airway to assist them in breathing better during sleep. Surgeries may achieve this by eliminating excess tissue, using implants, or repositioning an individual’s jaw. Depending upon the individual’s condition, this may involve surgery for the jaw, nasal surgery, or surgery for the tongue and throat. Some individuals may need more than one procedure. Several studies have indicated that sleep apnea surgery may assist in improving sleep quality and decreasing the number of apnea events in properly selected patients.

Indications for Sleep Apnea Surgery

Sleep apnea surgery is usually indicated as a second line of treatment for sleep apnea when conservative treatment options such as continuous positive airway pressure (CPAP) treatment, positional therapy, oral appliance therapy, and weight loss have been ineffective in alleviating the symptoms of sleep apnea, such as snoring and sleep awakenings due to gasping or choking.

Obstructive sleep apnea is more common in obese men and women and in individuals with thick necks and small, reduced, or obstructed airway passages due to swollen tonsils, a large tongue, a deviated nasal septum, increased soft tissue of the palate or certain medical conditions. Aging, smoking, and high blood pressure are the other associated risk factors.

Preparation for Sleep Apnea Surgery

Preparation for sleep apnea surgery may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery. Your exam will include a full evaluation of your ears, nose, and throat.
• Diagnostic tests such as routine blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
• You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
• You are advised to abstain from smoking for a defined period before and after surgery as smoking may cause breathing issues during the surgery, as well as slow down the healing process.
• You should not consume any solids or liquids at least 8 hours before surgery.
• A written consent will be obtained from you after the pros and cons of the surgery have been explained.

Types of Sleep Apnea Surgeries

The different types of sleep apnea surgeries focus on a few different body regions, all of which can keep you from breathing well in your sleep:

• Nose
• Tongue
• Palate, the soft tissue in the back of your mouth and throat
• The bones of your face, neck, and jaw

To determine which structure is obstructing your airway and which surgery may be ideal for you, your physician will use an instrument called nasopharyngoscope. A nasopharyngoscope is a flexible tube with a light and a camera on the end that is passed through your nose and down the back of your throat to detect airway obstructions.

Several surgical procedures can help improve sleep apnea. Some are minimally invasive outpatient procedures requiring local anesthesia, while others are more invasive procedures requiring general anesthesia and a hospital stay. Some of the common types of sleep apnea surgery include:

• Uvulopalatopharyngoplasty (UPPP): This is the most common type of sleep apnea surgery performed to treat sleep apnea. During this procedure, your surgeon will remove part of your palate along with your tonsils and uvula to widen the airway and allow air to move through the throat more easily. This reduces snoring and may be effective in select mild to moderate cases of sleep apnea.
• Nasal surgery: Nasal surgery can assist in reducing airway obstructions in the nose. Sleep apnea can occur if there is a blockage in one of the following parts of the nose: nasal valve, septum, or turbinates. The most common nasal surgeries to address sleep apnea are septoplasty and turbinate reduction. They can improve sleep apnea symptoms by enlarging the septum or turbinates to allow air to flow freely through them.
• Palate surgery: For mild cases of sleep apnea, your physician may recommend soft palate surgery, also known as the 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 to stiffen it. When this happens, the firm palate tissue is less likely to rub into the pharynx, which can help improve sleep apnea and snoring.
• Adenoid or tonsil removal: For children with sleep apnea, physicians often recommend adenotonsillectomy. In this procedure, your surgeon removes the adenoids and tonsils. Removing these structures can open up the airways and improve sleep apnea.
• Tongue surgery: There are two different procedures involving the tongue. They include:
  • Tongue advancement: In this procedure, your surgeon moves the primary muscle of the tongue (genioglossus muscle) forward. They make a cut into the jawbone, move the muscle forward, and then use a titanium plate to keep it in place. Though generally effective, it requires an overnight stay and is more invasive than other interventions.
  • Tongue base reduction: Tongue base reduction is a procedure that reduces the amount of tissue in the base of the tongue. Your surgeon can do it either with an incision or by using radiofrequency waves. The incision surgery (midline glossectomy) is more invasive and requires an overnight hospital stay. The radiofrequency method is noninvasive but requires several sessions. Both can improve, but not necessarily cure, mild sleep apnea in about 60 percent of patients.
• Tracheostomy: In people with obesity, a tracheostomy may offer effective relief from sleep apnea. The procedure involves creating an opening to the trachea through the neck to allow oxygen a direct route to the lungs. Physicians sometimes recommend it as a last resort for people who have tried other treatments without success.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after sleep apnea surgery will involve the following steps:

• You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
• You may experience pain, inflammation, and discomfort in the operated area. Medications are prescribed as needed to manage these, along with antibiotics to address the risk of surgery-related infection.
• If you have undergone a tongue reduction surgery or UPPP, avoid mouthwashes as they may irritate the surgical site.
• You should get plenty of rest and avoid strenuous activities or heavy lifting for a defined period.
• You may need to stay in the hospital for a day or two before being discharged home. Arrange for someone to take you home as you will not be able to drive after surgery.
• If you experience excessive bleeding or signs of an infection, such as fever and redness or inflammation at the recovery site contact your physician immediately.
• Keep your follow-up visits as recommended to ensure a positive surgical outcome.

Risks and Complications

Sleep apnea surgery is a safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Excessive bleeding
• Infection
• Fever
• Nausea
• Deep vein thrombosis (DVT)
• Breathing problems
• Urinary retention
• Allergic/anesthetic reactions
• Throat dryness
• Numbness
• Tongue dysfunction or weakness
• Recurrence of obstructive sleep apnea
• Pain and swelling around the surgery site

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