Surgery Options for Sleep Apnea

If you have obstructive sleep apnea (OSA), parts of your airways close up while you sleep. That makes it hard to get a good night’s rest. Your treatment options include using a continuous positive airway pressure (CPAP) machine, wearing a mouthpiece, or losing weight.

If none of those help, your doctor might suggest surgery. The best operation for you will depend in part on the cause of your sleep apnea.

Nasal Surgery

It removes or shrinks whatever is blocking your nasal passage. That includes growths called polyps and curved bones along the wall of your nose called turbinates.

If you have a deviated septum, a surgery called septoplasty may straighten the soft bone that separates your nostrils. It’ll probably take several weeks for the inside of your nose to heal.

Palate Surgery

Your surgeon reshapes the soft tissue in the roof of your mouth (palate) and around the sides of your throat. It can be done several different ways, but they all widen your airways.

Uvulopalatopharyngoplasty (UPPP). This is one of the most common surgeries for OSA in adults. Your doctor will remove part of your palate along with your tonsils and uvula, the dangly tissue above the back of your tongue. You’ll get UPPP at the hospital, and you won’t be awake for the procedure. Healing might take 6-8 weeks. Rarely, you could have voice changes or long-term problems swallowing. But these side effects are less likely to happen with new techniques.

Adenoid or tonsil removal. These are lymph nodes behind your nose or on the sides of your throat. One or both can swell up and block your airways. If you only get your tonsils removed, that’s called a tonsillectomy. Kids with OSA often need an adenotonsillectomy. That’s when doctors take out their tonsils and adenoids.

Laser or cautery-assisted uvulopalatoplasty (LAUP). You might get this if your symptoms are mild. Your doctor can use a laser or electric current to zap off parts of your soft tissue. They’ll give you a shot to numb your throat for this in-office procedure. You can go home right after, but your throat might be sore for a few days.

Palate implants. If you have mild OSA, your doctor might put a few small rods in your throat. This is something they can do in their office after they numb your throat. Scar tissue will form around the implants 2-3 months later. That’ll stiffen up your soft palate.

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Tongue Surgery

This is another way to open your airways. Your doctor might remove tissue from the base of your tongue. That’s called a lingual tonsillectomy. They can also pull your tongue muscle forward and attach it to your chin bone. This surgery is called a genioglossus advancement.

Nerve Stimulation

This isn’t surgery. Instead, hypoglossal nerve stimulation (HNS) uses electricity to help you breathe easier. Your doctor will place a small device in your chest under your skin. It’s kind of like a pacemaker, but the wires attach to a nerve that controls your tongue muscle. While you sleep, an electrical signal can trigger this nerve to push your tongue forward when you breathe.

Your doctor is more likely to suggest HNS if:

  • You can’t use a CPAP
  • You’re 22 or older
  • You have a BMI of 35 or less

HNS isn’t recommended if you have a concentric collapse in your airway. That means the soft tissue in the roof of your mouth and your throat close in on all sides when you sleep. Your doctor can run some tests to find out if that happens to you.

Skeletal Surgery

Your doctor can move your upper and lower jaws forward to open up your throat. This is called maxillomandibular advancement (MMA). It’s not a common way to treat OSA, but your doctor might do it if you have structural problems with your face or head.

There’s some evidence that MMA works better than other surgeries for sleep apnea, such as UPPP. But it’s riskier and requires a longer recovery. That’s because your doctor has to break your jaws to reset them. If you do get this surgery, expect to stay in the hospital for 3-5 days. Your jaws might be wired shut for a few days.

Other Surgeries

Bariatric surgery. Your doctor might suggest this weight loss operation if you need to drop 100-125 pounds. Your airways can open up when you get rid of some fat.

Permanent tracheotomy. Your doctor will make a small opening in your windpipe. You’d breathe out of a special tube at night. That means you wouldn’t need to use your upper airways at all. You can cap the hole during the day. That way, you can breathe and talk normally. This may cure your OSA. But it’s a last-resort option.

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Which Surgery Is Right for You?

Your doctor will refer you to a special head and neck surgeon to figure that out. They’re called ear, nose, and throat (ENT) doctors, or otolaryngologists. During your exam, the ENT will likely put a small scope with a camera down your nose. They’ll check to see if there’s a problem with your nasal passages, throat, or tongue.

You might have more than one area that’s bulky, narrow, or closed off. If that’s the case, you may need a mix of surgeries. You can get some of them at the same time.

Does Surgery Cure Sleep Apnea?

A small number of people might get totally better after an operation, but there’s no guarantee. It’s more likely that your doctor will use surgery to lessen your symptoms and help other OSA treatments work better. Expect to keep using your CPAP after your procedure. But it might be more comfortable after surgery. That can make it easier to stick to your treatment.

WebMD Medical Reference Reviewed by Neha Pathak, MD on September 02, 2020

Sources

SOURCES:

Cleveland Clinic: “Sleep Apnea: Management and Treatment,” “Is Your Nose Working Against You? 5 Signs of a Deviated Septum,” “A Closer Look at Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.” 

UCLA Health: “Choosing Surgery to Treat Sleep Apnea.”

NYU Langone Health: “Recovery & Support for Deviated Septum,” “Surgery for Obstructive Sleep Apnea.” 

The Kaohsiung Journal of Medical Sciences: “Obstructive sleep apnea treatment in adults.”

Stanford Health Care: “Uvulopalatopharyngoplasty (UPPP),” “Tongue Surgery -- Treatment for Sleep Apnea,” “Genioglossus Advancement,” “Skeletal Surgery (Maxillomandibular Advancement).”

American Thoracic Society: “Obstructive Sleep Apnea In Children.”

Cleveland Clinic Journal of Medicine: “Alternative interventions for obstructive sleep apnea.”

Harvard Medical School (Healthy Sleep): “Surgical Treatments -- Sleep Apnea.”

Breathe Pennsylvania: “Upper Airway Stimulation Treatment for Obstructive Sleep Apnea?”

Neurotherapeutics: “Surgical Therapy of Obstructive Sleep Apnea: A Review.”

American Academy of Sleep Medicine (Sleep Education): “Surgery -- Surgical Procedures.”

Breathe: “Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all.” 

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