Surgery for Sleep Apnea

Surgery for sleep apnea and snoring is a good option for specific individuals. It is not for everyone. An experienced ENT (ear nose and throat) doctor performs these surgeries. Several sites of upper airway obstruction exit and the surgery is tailored to the individual. Such sites include the nasal passages (nose), the tongue, throat area and jaw structures. Remember, although some of these procedures can successfully eliminate snoring. Sleep apnea may persist and therefore needs treatment.

Keep in mind that success for sleep apnea after surgery is variable, but it is about 60%. Also, the rate of success might decrease over time after the procedure, meaning sleep apnea can return. Is important to discuss YOUR success rate with your ENT doctor.

Remember, you need re-assessment for signs of sleep apnea after surgery on a routine basis.  Don’t assume that surgery will completely eliminate the apneas. Also, even if your snoring is completely eliminated, it does not mean that you have no apneas. You can have a snore-less sleep apnea. The snoring acts as an alarm. When surgery removes the tissues that produced the snore sounds, it is important to routinely re-assess for sleep apnea.

Surgeries:

  1. Tonsillectomy and uvulopalatopharyngoplasty (UPPP): this is the most common type of operation for sleep apnea. This surgery clears the obstruction around the throat and therefore widens it by removing the tonsils, adenoids and the uvula (the little flap that hangs at the back of your throat). It also improves the movements of the soft palate. The success rate for this surgery is around 50%. UPPP requires a hospital stay.
  2. Septoplasty: this is a nose surgery that corrects a deviated septum. Therefore, it can improve obstruction at the nasal passages and may alleviate snoring.
  3. Base of the tongue surgery: this surgery reduces the size of tongue through radiofrequency procedure.
  4. Maxillomandibular advancement (MMA): this is a major surgery where the maxilla (upper) and mandible (lower) jaw bones are actually moved forward. A desired side effect is that patients report that their face looks better.
  5. Laser-assisted uvulopalatoplasty (LAUP): this procedure can be done as an outpatient setting. It can eliminate snoring, but the success for eliminating apneas is more modest.
  6. Pillar Palatal Implant:  this procedure can be performed in the  outpatient setting. It is used to treat snoring and the mild forms of sleep apnea. The doctor typically insets polyester string into the soft palate which act to reduce the vibration and movement of the soft palate.
  7. Tracheostomy: the surgeon creates an opening in the neck that acts as a passageway to the windpipe. Air can get into the lung directly and bypasses obstructions at the throat and nose. It is reserved for morbidly obese individuals or others with facial abnormalities whose apneas are severe and life threatening and have failed other conventional treatments.

Surgery for children with sleep apnea

The majority of children who have snoring and/or sleep apnea have enlarged tonsils and/or adenoids. In those cases, surgically removing the tonsils and possibly adenoids cure the sleep disordered breathing. According to the 2002 American Academy of Pediatrics, Clinical Practice Guidelines, “adenotonsillectomy is the first line of treatment for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or do not respond to surgery.”

They also recommend that “patients should be reevaluated postoperatively to determine whether additional treatment is required”. This means that after your child has the surgery, a follow-up evaluation, which likely includes a sleep study, is needed to make sure there are no signs of sleep apnea.