Sleep Apnea Surgery: Effective Treatment Options

Sleep Apnea Surgery can be a life-changing solution for those with obstructive sleep apnea (OSA). At Michigan Medicine, there are many surgeries to treat sleep apnea¹. These surgeries are done by experts in ear, nose, and throat (ENT) or oral and maxillofacial fields. They focus on removing blockages in the airway, like extra tissue or moving the jaw or tongue.

Table of Contents

Key Takeaways

Surgical treatments for sleep apnea can eliminate or improve the condition, reducing the need for CPAP or other appliances.
Procedures target physical obstructions in the airway, such as excess tissue or misaligned jaw and tongue.
Surgical options include UPPP, tonsillectomy, maxillomandibular advancement, and tongue reduction, among others.
Success rates vary, with some procedures achieving over 85% symptom reduction or cure rates as high as 57%.
Candidacy for surgery depends on factors like overall health, tobacco use, and personal preferences.

What is Surgery for Sleep Apnea?

Sleep apnea is a serious condition that can harm your health if not treated. Often, doctors start with treatments like CPAP machines or oral devices. But, surgery might be an option for those who don’t get better with these methods².

Doctors suggest surgery when other treatments don’t work well. The surgery type depends on the sleep apnea cause, severity, and the person’s anatomy. Before surgery, a detailed check-up, possibly a sleep study or endoscopic exam, helps decide the best treatment².

For obstructive sleep apnea (OSA), surgery can include removing or shrinking tissue, moving the jaw, nerve stimulation, or making a new airway. For central sleep apnea (CSA), treatments aim at the underlying health issue. The main goal of surgery is to make breathing easier and lessen sleep apnea episodes².

Remember, surgery isn’t a universal fix for sleep apnea. It’s crucial to talk with a healthcare expert before deciding on surgery. They can look at your specific situation and help you choose the best treatment³²⁴.

“The decision to undergo surgery for sleep apnea should be carefully considered, as it involves potential risks and a recovery period. However, for many individuals, it can be a life-changing solution that improves their quality of life and overall health.”

Mouth, Throat, and Windpipe Surgeries

Surgeries for the mouth, throat, and windpipe help treat obstructive sleep apnea (OSA). Uvulopalatopharyngoplasty (UPPP) is a common procedure. It removes excess tissue to widen the airway and improve airflow⁵. Tonsillectomy and adenoidectomy, especially for kids, also help by removing tonsils and adenoids⁵. These surgeries aim to clear up blockages in the upper airway.

Uvulopalatopharyngoplasty (UPPP)

UPPP is a top surgery for sleep apnea, focusing on the mouth and upper throat⁵. It removes the uvula, tonsils, and extra soft palate tissue to widen the airway⁶. Modern UPPP uses less tissue and focuses on rebuilding, making it safer and more effective⁶.

Tonsillectomy and Adenoidectomy

Removing adenoids or tonsils is a surgery option for kids with sleep apnea⁵. It helps clear blockages in the upper airway, making breathing easier during sleep⁶. Studies show good results in 85% of pre-puberty kids with sleep issues⁷.

Other surgeries for sleep apnea include tongue reduction, lingual tonsillectomy, and more⁵. These procedures are getting better, focusing on better results and patient comfort⁶.

Surgery might be suggested if CPAP or oral devices don’t work or are hard to use. It aims to stop or lessen sleep apnea symptoms⁶. Before surgery, tests and evaluations help pick the best treatment for each patient⁶.

surgery for sleep apnea

If you have sleep apnea, you might think about surgery to fix the problems. CPAP therapy is often the first choice, but surgery can also help some people. Let’s look at the different surgeries for sleep apnea.

One surgery is called uvulopalatopharyngoplasty (UPPP). It removes the uvula, tonsils, and parts of the soft palate. Recovery takes about six to eight weeks⁸. Another choice is laser-assisted uvulopalatoplasty (LAUP) or cautery-assisted uvulopalatoplasty (CAUP). These can be done in a doctor’s office and don’t require an overnight stay⁸.

For tongue collapse, tongue surgery might be suggested. This includes tongue reduction or lingual tonsillectomy to widen the airway⁸.

Nasal surgeries like septoplasty or turbinate reduction can help if your nose is blocking your airway. These surgeries are shorter recovery times and are usually easier to handle than other sleep apnea surgeries⁹.

If you have a narrow retrolingual space or didn’t get better with soft palate surgery, maxillomandibular advancement (MMA) might be an option. This moves the upper and lower jaws forward to make more room for air⁸.

There are also nerve stimulation devices, like the Hypoglossal Nerve Stimulator (Inspire). This device is implanted and helps control tongue movements during sleep⁹.

The best surgery for you will depend on your specific needs and the cause of your sleep apnea. It’s important to talk to a healthcare provider to find the right treatment for you.

Jaw Surgery

Maxillomandibular Advancement (MMA)

For people with serious sleep apnea, maxillomandibular advancement (MMA) surgery might help. This surgery moves the upper and lower jaws forward. It makes the airway bigger and helps air flow better¹⁰.

About 86% of patients find MMA successful, and 39% are cured of sleep apnea¹⁰. But, it’s a big surgery that changes how you look and has risks¹⁰.

More than half of MMA patients stop having sleep apnea, with an AHI under 5¹¹. Around 70% say they look better after surgery, and 20-25% see little change¹¹.

Orthognathic surgery, like MMA, works over 90% of the time for sleep apnea¹². It’s often for those who didn’t get better with other treatments. This shows it’s good for tough cases¹².

Recovering from MMA surgery takes about six weeks, with most people getting back to normal in three weeks¹¹. Eating well and exercising can also help prevent sleep apnea, especially if you’re overweight¹⁰.

“Corrective jaw surgery can improve obstructive sleep apnea symptoms such as excessive fatigue, loud snoring, morning headache, and sleepiness.”

¹⁰

Tongue Surgeries

For people with obstructive sleep apnea (OSA) where the tongue blocks the airway, tongue surgeries can help. These surgeries move or shrink the tongue to keep the airway open during sleep¹³.

Genioglossus advancement moves the tongue-protruding muscle forward. This stops it from blocking the airway¹³. Midline glossectomy cuts down the tongue base size by removing part of the middle and back¹⁴. Hyoid suspension moves the hyoid bone and tongue muscles to widen the airway¹³.

Tongue surgeries for sleep apnea work best with other treatments, not alone¹³. The choice depends on the patient’s body, what they prefer, and the surgeon’s skills¹⁴.

These surgeries have risks like pain, swelling, and trouble swallowing¹⁵. Patients should talk to their doctor about the risks and benefits before choosing a treatment for sleep apnea¹³.

“Tongue-based procedures can be an important component of a comprehensive treatment plan for obstructive sleep apnea, especially when other airway issues are also addressed.”

Nasal Surgeries

For some people with obstructive sleep apnea (OSA), fixing nasal obstructions is key to a full treatment plan¹⁶. Nasal surgery can help with symptoms like feeling sleepy and breathing issues during sleep¹⁶. But, it usually doesn’t greatly improve the apnea-hypopnea index (AHI), which measures serious sleep apnea blockage¹⁶.

Still, surgery can make breathing easier, making treatments like CPAP and oral devices work better¹⁶. How well nasal surgery works depends on the severity of the blockage, the sleep apnea level, and other factors¹⁶.

A study in the September 2015 issue of Otolaryngology–Head and Neck Surgery found most studies showed no big drop in AHI from nasal surgery for OSA¹⁷. But, the Epworth Sleepiness Scale (ESS) went down in eighteen studies after surgery¹⁷.

Surgeries like septoplasty, turbinate reduction, and nasal valve surgery can clear up nasal blockages and improve breathing¹⁷. They might not greatly change the AHI, but they can make symptoms better and help other treatments work better¹⁶¹⁷.

In summary, nasal surgery can be part of a full treatment plan for some OSA patients, especially those with big nasal blockages¹⁶¹⁷. But, its effect on sleep apnea can vary. It’s often used with other treatments for the best results¹⁸.

Nerve Stimulation Surgeries

For some people with sleep apnea, a special surgery called hypoglossal nerve stimulation (HNS) might help. This surgery puts a small device in that sends signals to the hypoglossal nerve. This nerve controls the tongue’s movement, keeping the airway open while you sleep¹⁹.

People with moderate to severe sleep apnea might be good candidates for HNS. They usually have an apnea-hypopnea index (AHI) score between 15 and 65¹⁹. The Inspire device, the only FDA-approved HNS system, has shown to improve sleep apnea symptoms, snoring, and quality of life¹⁹²⁰.

The surgery for HNS takes about two to three hours and is done as an outpatient under general anesthesia¹⁹. The device has a breathing monitor, pulse generator, and cuff electrode. These work together to stimulate the nerves under the tongue, helping with breathing at night¹⁹.

Even though HNS is usually safe, there are risks like infection, bleeding, nerve damage, scar tissue, and problems with the implant parts¹⁹. The battery lasts about 11 years, and if needed, parts can be replaced with an outpatient surgery¹⁹.

Some people might feel the stimulation, have a sore tongue, trouble swallowing or speaking, or issues with the tongue muscles after HNS¹⁹. Insurance, including Medicare, often covers part of the costs for the device and treatment for those with a BMI of 32 or less¹⁹.

Since 2014, the Inspire device has changed lives for many with moderate to severe sleep apnea²⁰²¹. It’s a surgical option that could improve sleep and health for those who can’t use traditional treatments²⁰²¹.

Weight Loss Surgeries

If you’re overweight and have sleep apnea, your doctor might suggest weight loss surgery. Losing 100-125 pounds can make your airway bigger and help you breathe better at night²². This surgery is often recommended for people who are very overweight or obese²³.

Research shows that weight-loss surgery can lower the risk of heart problems by 42% and death by 37% in sleep apnea patients²². It also leads to a 9.1% chance of death from any cause at 10 years, which is less than the non-surgery group²².

People who have this surgery tend to keep losing weight for over 10 years, losing about 33.2 kg on average²². This is more than the 6.64 kg lost by those who didn’t have surgery²². It also cuts the risk of serious heart events by 27% at 10 years²².

With over half of Americans overweight and 12 million with severe obesity²³, many people with sleep apnea consider this surgery. They are more likely to have health problems like high blood pressure, diabetes, and sleep apnea²³. This surgery helps cure 80 to 85% of sleep apnea cases²³.

If you’re dealing with obesity and sleep apnea, talk to your doctor about weight loss surgery. It could greatly improve your breathing, lower heart risks, and help you manage your weight for the long term.

Comparing Surgical and Non-Surgical Treatments

Surgery is usually the last choice for sleep apnea treatment. Doctors first try less invasive methods like CPAP therapy or oral devices²⁴. These methods often help manage symptoms and lower health risks²⁴.

But, some people need surgery if other treatments don’t work. Surgery can fix issues with the mouth, throat, windpipe, or even help with weight loss²⁵. Surgery can help, but it also has risks like infections or bleeding²⁵.

Even after surgery, some patients might still need CPAP or other therapies²⁴. The choice to have surgery should be talked over with a doctor. It’s important to think about the benefits and risks for your situation.

Treatment	Potential Benefits	Potential Risks
CPAP Therapy	Effective in managing sleep apnea symptoms Reduces associated health risks	Nosebleeds Sore throat Headaches
Sleep Apnea Surgery	Reduced snoring Decreased daytime sleepiness Easier CPAP use or potential CPAP independence	Infection Bleeding Anesthesia reaction Specific risks related to each surgical procedure

Choosing the right treatment for sleep apnea means getting a personalized plan²⁴. Working with healthcare experts helps find the best option, whether it’s CPAP, surgery, or something else. This way, you can find what works best for you.

“The management of sleep apnea syndrome involves a multidisciplinary approach, encompassing specialties like cardiology, ophthalmology, and metabolic health.”²⁴

Candidates for Sleep Apnea Surgery

Not every patient with sleep apnea is a good fit for surgery. Doctors look at the type and severity of sleep apnea, the patient’s health, and the surgery’s success rate²⁶. Some conditions, like central sleep apnea or uncontrolled health issues, might mean surgery isn’t an option²⁶. A detailed check-up helps find the best treatment.

A study in the Journal of Oral and Maxillofacial Surgery in 1993 talked about a new surgery for sleep apnea²⁷. In 1986, another study suggested surgery like maxillary advancement as an alternative to tracheostomy²⁷. Surgery is considered when other treatments don’t work or aren’t right for the patient²⁸. The best candidates are those who have tried other treatments and have done so for several months²⁸.

Texas ENT Specialists offer surgery options in the Houston area, like radiofrequency and turbinate reduction²⁸. The goal is to help with sleep apnea, reduce snoring, and make breathing easier²⁸.

Surgical Procedure	Potential Benefits	Possible Risks
Uvulopalatopharyngoplasty (UPPP)	Increases effectiveness in some patients compared to older methods²⁶	Bleeding, infection, swallowing issues, speech or taste changes, throat narrowing, tooth or lip injury, and ongoing snoring or sleep apnea²⁶
Tonsillectomy and Adenoidectomy	Can be done with palate surgery or separately, with TORS for some²⁶	Bleeding, infection, swallowing issues, speech or taste changes, throat narrowing, tooth or lip injury, and ongoing snoring or sleep apnea²⁶
Hypoglossal Nerve Stimulator Implantation Surgery	Stimulates the tongue to open the airway at night, for those who can’t use CPAP²⁶	Bleeding, infection, tongue weakness, lip weakness, scar formation, speech changes, lung collapse, and device issues²⁶
Maxillomandibular Advancement (MMA)	Moves the jaw to improve airway support, evaluated by specialists²⁶	Bleeding, infection, swallowing issues, speech or taste changes, throat narrowing, tooth or lip injury, and ongoing snoring or sleep apnea²⁶
Nasal Procedures	Various in-clinic treatments for snoring or mild sleep apnea, needing a sleep study first²⁶	Bleeding, infection, breathing issues, appearance changes, and ongoing snoring or sleep apnea²⁶

Not all sleep apnea patients can have surgery. Doctors look at the patient’s condition, treatment history, and surgery success chances before suggesting surgery. Patients thinking about surgery should get a full check-up to find the best treatment.

Conclusion

Sleep apnea surgery can help those who don’t get better with non-surgical treatments like CPAP²⁹. It focuses on different parts of the body, such as the mouth, throat, and nose²⁹³⁰. The right surgery depends on your unique situation and body structure, found through a detailed check-up.

Surgery isn’t right for every sleep apnea patient²⁹³⁰. You need a full check-up to see what’s best for you. This might mean surgery, other treatments, or a mix of both³⁰. Talking with your doctor can help you find the best way to treat your sleep apnea.

The main aim of treating sleep apnea is to make your life better and lower health risks²⁹³⁰. You might choose surgery, other treatments, or a mix. Your healthcare team will help you pick the best option for your sleep apnea.

FAQ

What is surgery for sleep apnea?

Surgery for sleep apnea aims to fix blockages in the airway. This includes removing extra tissue or adjusting the jaw or tongue. It’s used when treatments like CPAP or oral devices don’t work.

What are the common surgeries for obstructive sleep apnea?

Common surgeries for OSA include uvulopalatopharyngoplasty (UPPP), tonsillectomy, and adenoidectomy. Other procedures are lateral pharyngoplasty, lingual tonsillectomy, palatal z-plasty, and tongue reduction surgery. These help clear blockages in the airway.

How does maxillomandibular advancement (MMA) surgery work for sleep apnea?

MMA surgery moves the upper and lower jaw forward. This widens the airway and helps improve breathing. It’s an option for those with moderate to severe sleep apnea and works well in almost 86% of cases.

What are tongue-related surgeries for sleep apnea?

For tongue-related blockages, surgeries like genioglossus advancement, midline glossectomy, or hyoid suspension are used. These surgeries move the tongue muscles to improve airflow. They work best with other treatments.

How can nasal surgeries help treat obstructive sleep apnea?

Nasal surgeries can remove polyps, fix a deviated septum, or shrink turbinate size. This improves nasal airflow, which is crucial for breathing at night. It’s part of a full treatment plan for some OSA patients.

What is hypoglossal nerve stimulation (HNS) for sleep apnea?

HNS involves a device that stimulates the hypoglossal nerve. This nerve controls tongue movement to keep the airway open at night. It’s suggested for those who can’t use CPAP therapy.

Can weight loss surgery help treat sleep apnea?

For those overweight and have sleep apnea, weight loss surgery might be suggested. Losing weight can open up the airway and improve sleep breathing.

Who is a good candidate for sleep apnea surgery?

Doctors look at the type and severity of sleep apnea, the patient’s health, and surgery success chances. Some conditions, like central sleep apnea or uncontrolled health issues, might mean surgery isn’t suitable.