Surgery for Sleep Apnea

From the WebMD Archives

When you have obstructive sleep apnea, parts of your airway get blocked while you snooze. Your doctor can recommend several different treatments to help you breathe -- a device called CPAP (short for continuous positive airway pressure), a nerve stimulator, mouthpieces, or special pillows.

But if those don’t work for you, surgery is another way to treat sleep apnea. An operation won’t be the first thing a doctor recommends for the condition. He'll want to make sure you’ve given other treatments a try first. But when you and your doctor decide that you need another approach, you can think about the pros and cons of a surgical fix.

The kind of procedure you get depends on what’s causing your apnea, says Maurits S. Boon, MD, co-director of the Voice and Swallowing Center at Thomas Jefferson University Hospital. “Different parts of the airways collapse in different people, so we can’t generalize. The good news is that there are a lot of options.”

Types of Operations

Surgery focuses on a few different body parts, all of which can keep you from breathing well in your sleep:

  • Nose
  • Tongue
  • Palate, the soft tissue in the back of your mouth and throat
  • The bones of your face, neck, and jaw

To figure out what’s blocking your airway and what surgery might be best for you, your doctor will use a skinny tube called a nasopharyngoscope. It goes in through your nose and down the back of your throat. If it sounds uncomfortable, don’t worry: Your doctor will either numb the area or give you something to make you sleep.

With this method, your doctor “will get to see where the obstruction is and how it happens while you’re actually sleeping,” says Raj Dasgupta, MD, an assistant professor of clinical medicine, pulmonary, and sleep medicine at the University of Southern California.

Nasal Surgery

This can help when the bone and cartilage that split the left and right sides of your nose and nasal cavity are off-center. That’s called a deviated septum. Your doctor might also recommend this operation to remove any growths like polyps that might be getting in the way of your breathing.

This kind of surgery is usually not meant to cure obstructive sleep apnea, Boon says. “It’s more to improve the use of CPAP, to help the air from the CPAP get through. If you just fix the nose, it’s unlikely to get rid of the [apnea] entirely.”

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Tongue Surgery

There are two main types, but they have the same goal: to keep your tongue from blocking your airway when it relaxes while you’re asleep.

A lingual tonsillectomy takes out part of the base of the tongue. A genioglossus advancement firms up your tongue by pulling the muscle that attaches it to your jaw forward.

Palate Surgery

Doctors can do a few different operations on this area:

  • Tonsillectomy. A doctor takes out your tonsils if they're large enough to block your throat at night.
  • UPPP, or uvulopalatopharyngoplasty. The surgeon rearranges the tissue of your throat to make the airway bigger.
  • Palate radiofrequency. The doctor zaps the tissue at the upper part of the back of your throat, called the soft palate, with a small needle. As you heal, the tissue will get stiffer and shrink.
  • Palate implants. Small fiber rods stiffen the tissue to keep the airway open.

If you’ve ever had your tonsils out, you have an idea of what recovery is like after tongue and palate surgeries. You’ll have trouble swallowing and might be uncomfortable for 2 to 3 weeks. You might have some bleeding, too.

It’s rare, but tongue and palate surgeries can cause some long-term problems with swallowing, or feeling like something is stuck in the throat.

Skeletal Surgery

Some sleep apnea operations change the shape of your airway by moving your jawbones. In one type, called maxillomandibular advancement (MMA), the surgeon breaks your upper and lower jaws and moves everything forward to make your airway bigger.

Instead of opening just one part of the airway, as other types of surgery do, MMA opens every area where there could be a blockage, says Zhen Gooi, MD, assistant professor of surgery at the University of Chicago. “It’s much more invasive, but it has been shown to be very effective.”

MMA generally means a few days in the hospital, and you might have to take pain medication on and off for a week or two. After the procedure, you’ll have tight rubber bands to hold your jaws together, which your doctor will remove at each of your follow-up visits over the next few weeks.

Another type of surgery takes out part of the bone in your chin and pulls your tongue and neck muscles forward to make more space in your airway. It's called anterior inferior mandibular osteotomy with hyoid suspension. It doesn’t work as well as MMA, but you won’t need to have your jaws held together during your recovery.

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Team Effort

Experts agree that none of these operations are guaranteed to completely cure obstructive sleep apnea.

“Even after surgical procedures, some patients may still require CPAP. Surgery isn’t a magic wand,” Gooi says.

The effects of surgery also can wear off in the long run as a person ages, Boon says. “The natural history is that as we get older, things sag and start to get loose, and we start to gain weight. Both of those can cause sleep apnea or make it worse.”

Success is partly a team effort, Gooi says. “The best patient for this is a motivated one with realistic aims, who will include healthy lifestyle changes. That’s the patient who will be most pleased with surgery.”

WebMD Feature Reviewed by Melinda Ratini, DO, MS on May 02, 2016

Sources

SOURCES:

Harvard Medical School. “What Happens During OSA,” “Surgical Treatments.”

Maurits S. Boon, MD, associate professor, otolaryngology and head and neck surgery and co-director, Voice and Swallowing Center, Thomas Jefferson University Hospital, Philadelphia, Pa.

Stanford Health Care. “Sleep Surgery,” “Tongue Surgery,” “Palate Surgery,” “Skeletal Surgery.”

Raj Dasgupta, MD , FACP, FCCP, FAASM, assistant professor of clinical medicine, pulmonary and sleep medicine, University of Southern California Keck School of Medicine, Los Angeles, Calif.

American Academy of Sleep Medicine. “Surgery – Surgical Procedures.”

Zhen Gooi, MD, assistant professor of surgery, University of Chicago Medical Center, Chicago, Ill.

American Academy of Dental Sleep Medicine. “Upper Airway Surgery.”

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