Surgical treatment for obstructive sleep apnea (OSA) involves the removal of excessive tissue that could be blocking your upper respiratory airway and restricting your breathing. There are various surgical treatment options, each for a specific indication and with a varying success rate.
Usually, an ENT (Ear, nose, throat) surgeon performs such surgeries but an opinion for surgical intervention should be sought from a sleep specialist.
Obstructive sleep apnea is a type of sleep apnea, which occurs due to the collapse of the uvula and the soft tissues such as those of the palate causing interruption of the breathing process during sleep. Both, the uvula and palate vibrate and cause the distinct sound of snoring.
Due to this interrupted breathing, two adverse things take place:
- The first is the interruption of your breathing, which results in low oxygen levels in the blood and subsequent low oxygen supply to the organs of the body such as the brain and the heart.
- The second thing is that due to these breathing interruptions, you tend to awaken several times during the night.
You are awakened during the distressed breathing because when you are awake, the muscles at the back of your throat tighten and pull up these soft tissues of your palate and prevent them from blocking the airway.
You are then able to breathe freely. Due to this off-and-on awakening, your sleep suffers without the right amount of sleep hours and the disturbances in your sleep cycle. These breathing cessations can occur hundreds of times during the night depending on the severity of your sleep apnea.
This happens every night and over time you become a potential candidate for complications of sleeplessness and the effects of sleep apnea on your body. Some of these complications are in them individually dangerous; together their dangers multiply.
Treating your sleep apnea, therefore, becomes all the more essential.
Surgery for obstructive sleep apnea is indicated as a last resort when other sleep apnea treatment options like CPAP have failed or there is non-compliance.
Sleep apnea surgery options
The choice of surgery for obstructive sleep apnea varies from individual to individual and depends on the cause of sleep apnea.
Surgery in adult obstructive sleep apnea (OSA) has undergone significant improvements over the years and continues to develop for the better with improved success rates. The following are the various surgery options that can be adopted.
1. Nasal surgery
Nasal surgery is indicated when something is obstructing your nasal passage. It could be a nasal polyp or inflamed turbinates or a deviated nasal septum.
Nasal surgery also increases the tolerance to CPAP, which becomes an advantage because a nasal obstruction does decrease the tolerance to using CPAP.
2. Palate implants
Palate implant surgery or palatoplasty is indicated in patients with mild sleep apnea in whom there is a collapse of the soft palate, which causes an obstruction of the airway.
Palate implants stiffen the soft palate and prevent its collapse into the pharynx, which forms the upper part of the airway. Palate implants also reduce the vibrations of the soft palate helping to stop snoring.
3. Uvulopalatopharyngoplasty (UPPP) for sleep apnea
UPPP is a surgery performed in a hospital under general anesthesia. It removes part of the uvula, part of the palate and soft tissue around it, tonsils, and adenoids to remove the obstruction of the airway caused by these tissues.
UPPP restores normal breathing and stops snoring.
4. Maxillomandibular advancement (MMA)
As the name suggests, this surgery moves the jaw and the upper teeth forward. This results in the base of the tongue and the palate coming forward and space between them increases giving you a more potent airway.
The oral surgeon and an orthodontist perform this surgery. In this surgery, the jaw and the maxilla are cut, moved forward, realigned, and plated into place. The success rate of this surgery can be up to 90%. This surgery is suitable for thin patients with small jaws.
Tracheostomy is indicated in life-threatening sleep apnea and when other treatments have failed.
In this surgery, an opening is made in your trachea (windpipe) below the Adam’s apple to bypass the narrowed and obstructed upper airway.
A metal or plastic tube is then inserted into the trachea through which you can breathe. This opening is covered during the day by capping the tracheostomy tube and is opened during the night to ensure proper breathing and prevent sleep apnea attacks. The success rate of tracheostomy is almost 100 % in preventing sleep apnea.
6. Laser-assisted uvulopalatoplasty (LAUP)
Laser-assisted uvulopalatoplasty (LAUP) is a new surgical procedure, which has gained additional popularity as a treatment for obstructive sleep apnea.
It is an outpatient procedure that involves partial resection of the uvula and soft palate with the help of a laser.
For treating snoring, LAUP boasts of 80% to 85% success rates. Data that are available suggest that the efficacy of LAUP in patients with OSA is no better than uvulopalatopharyngoplasty (UPPP). However, there is concern over the possibility that LAUP might actually cause worsening of OSA in some patients.