Surgical Therapy for Obstructive Sleep Apnea
Syndrome

Surgical therapy for obstructive sleep apnea (OSA) is usually a treatment of last resort, and is only used when other non-surgical treatments such as continuous positive airway pressure (CPAP) machines, the use of oral appliances, or position therapy have failed. Surgical therapy for sleep apnea is likely to include more than one surgery, as the chances for success of any single procedure are often below 50 percent, according to the American Sleep Apnea Association (ASAA).

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Before surgery is considered, each patient should be evaluated to confirm the diagnosis of sleep apnea and to measure the severity of the case. Since surgery can often involve significant recovery periods, and does not guarantee a cure for sleep apnea, most doctors try other treatments before turning to surgery.

Surgery that uses general anesthesia also has special risks for patients with sleep apnea, as the anesthesia can actually cause increased apnea episodes for some time after surgery. Anesthesiologists are aware of the increased risk, and doctors should educate patients about this possible side effect before the surgery takes place.

Patients with severe sleep apnea who have not received any symptom relief from CPAP therapy or an oral appliance may find surgery as a promising option. The effects of surgical therapy may be immediate: deeper sleep with fewer or no episodes of apnea during the night. Sometimes these positive effects are temporary, and more surgery may be required to further treat the apnea.

Doctors use a few different surgical procedures to treat sleep apnea, and each has its own set of risks and benefits. These should be thoroughly discussed by both doctor and patient before the surgery, as well as the chances for success and the possible need for additional surgery in the future.

During this procedure, surgeons might remove:

• The uvula, a small piece of tissue that hangs down into the throat
• Part of the soft palate, the soft tissue that makes up the roof of the mouth
• Any excess tissue in the throat
• Tonsils and adenoids
• Portions of the pharynx

Recovering from this surgery can take up to three weeks, and during this time, swallowing can be extremely painful. According to the ASAA, UPPP has about a 40 percent chance of success for patients. This surgery can affect speech, making it more nasal and causing a lot of drainage of secretions into the throat. Occasionally, food may get into the back of throat where the uvula used to be and cause discomfort and coughing spells, but this can be prevented if doctors use a variation of the classic UPPP called the revised UPPP. This surgery leaves the uvula intact, while still reducing excess tissues in the upper airway to improve OSA symptoms.

Laser midline glossectomy involves surgically modifying the size and shape of the soft tissue portions of the tongue’s base. This procedure is sometimes used by physicians after a UPPP fails to resolve OSA symptoms. This procedure also involves painful swallowing after surgery, but it has been shown to be effective in treating OSA syndrome.

The goal of this extremely complex procedure is to move the entire tongue muscle forward, and attach the hyoid bone to the jaw. This is done to prevent airway collapse due to movement of the hyoid bone or obstruction due to a large or badly placed tongue base. Another related procedure is maxillomandibular osteotomy and advancement, which is a variation on the above procedure and also seeks to move the tongue muscle forward.

The tracheotomy is the most extreme type of surgical therapy for obstructive sleep apnea syndrome. The surgeon cuts an opening in the windpipe, or trachea, and then inserts a tube into the opening. This tube has a valve that opens and closes, and it allows for normal speech and breathing during the day. When the valve is opened at night, air flows directly into the trachea, bypassing any blockages in the upper airway.

Tracheotomies are now done only when the other surgical procedures have failed, and non-surgical approaches have all been tried. The surgery may cause difficulty in speaking, emotional issues with the altered appearance of the throat, and a higher risk of developing lung infections. The advantage to a tracheotomy is that it has a very high success rate for curing OSA.

No article is a substitute for a long conversation with a surgeon who is experienced in sleep apnea surgery. He or she can show the patient exactly where in the throat the operation will be, what will be removed, and discuss the ultimate goal of each procedure performed. Ask questions and thoroughly understand the answers before surgery. Don’t be afraid to get a second opinion or to seek out a more experienced surgeon, as more experience may translate into a higher success rate for sleep apnea surgery. Surgical therapy for OSA can be a bit intimidating, but knowing what to expect can make the preparation, surgery, and recovery so much easier.

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