Sleep Apnea Surgical options

There are numerous surgical treatment options for sleep apnea. The type of surgery specifically suited for a particular patient will depend on the severity of sleep apnea and an individual’s specific anatomy. Most people opt for the surgical option because it promises a permanent cure with a single surgery.

Surgery appears more convenient as compared to wearing a mask or an oral appliance every single night. The downside is that surgery will require time off from your daily schedule to heal; the pain can also last for two to three weeks. Before opting for the surgical option a patient should be fully informed of all the potential general risks of surgery which include;

  • Excessive bleeding
  • Bacterial infection
  • Scar tissue
  • The possibility of change in voice
  • A surgery may fail hence not cure sleep apnea ultimately
  • Swallowing issues
  • Anesthesia risks such as stroke, heart attack and allergic reactions

Surgical option should only be a viable consideration after a careful and thorough assessment of all the risks and alternatives. Most insurance companies actually require a three week trial with CPAP therapy. Keep in mind that as compared to other treatment options, a surgery is more likely to cause serious and irreversible complications.

How to choose a suitable surgical option?

The surgical treatment you ultimately select should address key anatomic problem areas. Sometimes a patient can have several areas that compromise airflow leading to sleep apnea. The rate of success is measured by ascertaining whether or not airway obstruction or collapse is prevented.

Here is a brief but detailed coverage of viable surgical options;

1.) Nasal airway surgery

There is a type of sleep apnea caused by nasal obstruction alone. There are a number of things that can cause a nasal obstruction such as septal deviation, turbinate swelling and sometimes nasal polyps. Nasal airway surgery addresses all these potential causes. This surgery is mostly used to improve the effectiveness of CPAP therapy as nasal obstruction makes CPAP therapy intolerable.

2.) Palate and Pharyngeal Surgery (Uvulopalatopharyngoplasty [UPPP])

These surgical procedures are aimed at stabilizing the roof/palate and the pharynx to help keep the airway open. Essentially this surgery prevents the collapse of the tonsils, pharynx and palate which is a common occurrence in sleep apnea.

A UPPP surgery is always performed under general anesthesia and takes 2 to 3 weeks to heal. During the postoperative period, patients should maintain a liquid diet coupled with pain medication. Reliable statistics indicate that UPPP surgeries are successful most of the time.

3.) Upper Airway Stimulation Therapy (UAST)

This is a relatively new surgical therapy that essentially involves the implantation of a tiny generator similar to a cardiac pacemaker in the anterior chest. This small generator helps to stimulate the hypoglossal nerve to keep the airway muscles functional during sleep. The UAST surgery aims at preventing muscle relaxation and subsequent airway obstruction.

A patient turns on the implanted generator using a small hand held remote, no mess! and no external hoses! The UAST surgery is actually considered as one of the best surgeries for sleep apnea because it does not in any way alter the anatomy of the airway.

4.) Tongue reduction surgery

Sleep apnea in some patients is caused by an area of collapse between the base of the tongue and the pharynx. This surgery is used to reduce the size of the base of the tongue so that the airway opened. Various devices are used by a surgeon strategically cut a trough down the middle of the base of the tongue.

This surgery is mostly used in combination with other procedures such as UPPP for optimum success.

5.) Genioglossus advancement

The genioglossus muscleis attached to the base of the human tongue and extends to the front of the jaw. Research has revealed that most sleep apnea patients the genioglossus muscle relaxes during sleep causing the airway to narrow and sometimes collapse. This surgery essentially detaches the part of the jaw where the genioglossus muscle attaches; the surgeon then moves the muscle forward by about 4 mm. Although this surgical option is less invasive, it is nonetheless less permanent and less effective.

6.) Hyoid suspension

The hyoid is a bone that supports the tongue and the larynx in the neck. This surgery involves suturing the hyoid bone close to the mandible; this ensures the tongue is pulled up and forward. This procedure is rarely done without any other additional procedures. It has a considerable success rate when performed expertly on the right patient.

7.) Tracheostomy

This is a surgical procedure performed to bypass the narrowed airway which is the main cause of sleep apnea. It is mostly performed on morbidly obese patients who suffer from sever sleep apnea. While is procedure is very effective and high has a high success rate, it also has risks and complications such as;

  • The psychological issue of walking around with a tube coming out of the neck
  • Infections are common and scar tissue also forms both on the outside and inside of the hole

Tracheostomy is rarely done as it actually reserved as a last resolve and a life saving options for morbidly obese patients.

Bottom-line

Surgery has a high success rate in permanently treating sleep apnea. However, because of the potential detrimental side effects, a patient needs to seek the advice and guidance of a doctor.