Surgery is one treatment option for obstructive sleep apnea. The first step in sleep apnea surgery entails evaluation by a sleep apnea surgeon. Sleep apnea surgeons are usually otolaryngologists also known as ear, nose and throat surgeons. Occasionally, oral maxillofacial surgeons perform sleep apnea surgery.
Types
Three broad types of sleep apnea surgery are available: nose surgery, throat surgery and jaw surgery.
One type of nasal surgery for sleep apnea involves removing the nasal turbinates. Nasal turbinates occupy the spaces in the nose and serve to humidify air when people breathe. A second type of nasal surgery for sleep apnea results in straightening a deviated nasal septum. The nasal septum divides the nose into left and right sides. Last, improving the internal nasal valve is another nasal surgery performed in the nose for sleep apnea. The internal nasal valve holds the nostrils open when a person takes a deep breath. Therefore, reinforcing it helps nasal breathing.
Throat surgery refers to tonsillectomy or uvulopalatopharyngoplasty. Tonsils are lymphatic tissue in the back of the throat. When they are enlarged, a surgeon may recommend removal with the goal of opening the airway. Uvulopalatopharyngoplasty is a procedure that is usually done at the same time as tonsillectomy. According to MayoClinic.com, this procedure involves removal of part of the uvula and excess tissue in the back of the throat and roof of the mouth. The uvula hangs down the back of the throat in a V shape. Removing this tissue theoretically enlarges the airway.
The last type of sleep apnea surgery is a bone or jaw surgery called maxillomandibular advancement. Maxillomandibular surgery involves moving the upper and lower jaw forward to enlarge the entire airway.
Features
On his website, Sleepapneasurgery.com, world-renowned sleep apnea surgeon Dr. Kasey Li writes that, "surgical management of the condition usually involves enlarging the airway by removal of soft tissues, or by expansion of the jaw structures that are restricting it." After evaluation, the surgeon will recommend a surgery or combination of surgeries aimed to enlarge the airway. Which surgeries she recommends will vary depending on individual anatomy.
Effectiveness
Effectiveness of sleep apnea surgery depends on factors that include selection of procedures, age, weight, severity of obstructive sleep apnea and individual anatomy. For example, if an individual has very large tonsils blocking the airway, removing them is much more likely to improve sleep apnea. The current medical research shows conflicting and controversial results on effectiveness for most sleep apnea surgery. One exception to this rule applies to maxillomandibular advancement. While referring to maxillomandibular advancement, Dr. Li writes, "This procedure serves as the most effective surgical treatment for obstructive sleep apnea."
Nasal surgery alone allows individuals to tolerate the sleep apnea mask better, but it is not an effective treatment by itself for sleep apnea.
Risks
Sleep apnea surgery involves general anesthesia. Having general anesthesia always confers a risk of death. Sleep apnea surgery often includes throat or airway surgery. After airway surgery, concern exists for swelling and closure of the airway resulting in respiratory distress. As with any surgical procedure, post-operative bleeding and infection are additional concerns. When an individual undergoes sleep apnea surgery, there is a small chance the sleep apnea may worsen despite the surgery.
Time Frame
Swelling in the tissue around the surgical site remains present for several months after surgery. Therefore, a follow-up sleep study should be performed no sooner than four to six months after surgery to assess for results. The sleep study after surgery will be compared with the sleep study before surgery to look for improvement.
References
- MayoClinic.com: Obstructive Sleep Apnea: Treatments and Drugs - MayoClinic.com
- Sleepapneasurgery.com: Sleep Apnea Surgery -- Dr. Kasey Li -- Palo Alto, California
- Sleepapneasurgery.com: Sleep Apnea Surgery -- Dr. Kasey Li -- Palo Alto, California
- "Principles and Practice of Sleep Medicine"; Meir Kryger, Thomas Roth, and William Dement; 2005
