Chances are that you have heard that one has to go under the surgeons’ scalpel when sleep apnea condition is severe. How do you know whether your condition demands surgery? How is severity assessed?
Like the above question, there are several other doubts and apprehensions looming large regarding sleep apnea surgery, in case your doctor thinks this to be necessary to cure you. What are the surgical options? Which one would the doctor choose for me? What will my life be after the surgery is done? Can I lead a normal life after all this is over?
This article aims to provide you with detailed information about what you need to know when surgery is knocking at your door.
Assessment of severity
Sleep apnea treatment is based on how serious the condition is. Result from polysomnography, also called the sleep apnea test is the the diagnostic examination that reveals both the severity as well as the site of location of obstruction in the airway.
While the test provides an enormous amount of data, recorded while you were sleeping, one of the most important information you can get is the apnea-hypopnea index, or AHI. This is an index that is a combination of values of pauses in breathing (apneas) and the occurrences of shallow breathing episodes per hour (hypopneas). The calculation is done by dividing the number of such events by the hours that you were asleep. The figures below will give you an idea of how the severity is measured:
– Mild sleep apnea = AHI between 5 and 15
– Moderate sleep apnea = AHI between 15 and 30
– Severe sleep apnea = AHI 30 or more
Answers to some preliminary questions about surgery for sleep apnea:
– How does surgery help the apnea patient? The primary aim of apnea surgeries is to remove excess tissues located at different sites in the upper airway tract, so that the patient can breathe without pauses. It essentially aims to reduce or completely eliminate, if possible, breathing problems to a level that may be insignificant in clinical examinations. Incidentally, surgery for sleep apnea does not only involve removal of tissues – it also has to do some reconstruction of soft tissues of the uvula or soft.
– Other than the condition being serious, when else does the doctor think of surgery? When the patient is not compatible with CPAP and the condition is deteriorating progressively.
– What specialty of doctor would perform such surgeries? Sleep apnea surgeries are performed by an ENT (Ear, Nose and Throat) specialist who is also qualified in sleep medicines.
– Will my sleep apnea be cured if snoring is treated? Snoring surgeries does not always cure sleep apnea. at times it is also possible that the surgery may not fully cure the condition but merely reduce the number of apnea episodes. This eventually makes you more accessible to other forms of treatment. In some cases, surgery may turn the condition even worse.
– How successful are these surgeries? Different types of surgeries claim different success rates but on an average it is not more than 65%. This rate also falls over time.
– How much does a sleep apnea surgery cost? Cost is a relative term. When the doctor prescribes surgery, you need to keep an important point in mind. That is, cost that you might have to bear if you leave the condition untreated could be far higher than the cost of a surgery. University of Manitoba, Winnipeg did a study on this aspect and came up with the finding that a yearly cost of $500 before diagnosing the condition dropped to about $390 after it was diagnosed and subsequently treated.
– Will insurance pick up the bill? Though many insurance providers reimburse the cost of sleep apnea surgeries, they are choosy however about which surgery they would reimburse. However, you do get an opportunity to convince the insurance provider regarding the seriousness of your condition and the imminent need of surgery since the condition is life-threatening. They usually understand the need and urgency of surgery. However the insurance provider could ask for a referral when you want to consult a specialist or seek the help of a specific specialist.
– Is use of anesthesia safe for apnea patients? A majority of sleep apnea surgeries are done with the help of general anesthesia. Considering that anesthetics suppress the upper airway, one needs an experienced surgeon who can take care of this aspect of the operation. It is imperative that proper monitoring is done as well as facility for emergency artificial ventilation is kept ready when the patient is awakening and regaining consciousness. Anesthesia can narrow the airway and cause obstruction, even when small amounts of sedatives, etc are used. Thus to avoid post-operative breath
ing distress, it makes sense to carry one’s own CPAP (Continuous Positive Air Pressure) device during admission to the hospital. Some surgeons put their patients either in the intensive or intermediate care unit immediately after surgery to avoid post-surgical breathing complications.
Types of surgeries for sleep apnea and their success rates:
This surgery has three aims: width increase of airway at the throat opening; arrest the action of specific muscles that cause obstruction in the airway; betters the functioning of soft palate. It essentially eliminates soft tissues from the back of the throat. This is considered to be one of the most painful surgeries for sleep apnea with prolonged recovery time. Post-surgical complications include infection, weakening the functioning of throat muscles and soft palate, accumulation of mucus in the throat; problems with swallowing; loss of smell; regurgitation; change of voice, etc. However many complications are avoidable if the surgery is performed by an experienced surgeon. Efficacy is 40.7% according to the “Practice Parameters for the Treatment of Obstructive Sleep Apnea: Surgical Modifications of the Upper Airway,” issued in 1996 by the American Academy of Sleep Medicine.
Laser-Assisted Uvulopalatoplasty (LAUP)
This is essentially a variation of UPPP except in this case lasers are used to reduce the tissues at the back of the throat. A popular surgery for the treatment of snoring, its efficacy in tissue removal is less than UPPP. Capable of being performed at the doctors’ clinic, its efficacy in terms of curing apnea is under
question. Close to half the patients complain of dryness of throat after the surgery.
Pillar Palatal Implant:
This surgery is known for its non-invasive nature. Good for treating mild or moderate conditions as well as snoring, this surgery aims to diminish tissue vibration of the soft palate muscles. Taking only about 10 minutes to perform, the Pillar procedure is usually done in the doctors’ chamber. Efficacy can be compared to UPPP but not as painful. Recovery is also quicker.
There was a time when this was the only surgical option available for treating sleep apnea. Claiming 100% success, this surgery involves making an insertion at the neck through which a tube is inserted into the windpipe. This perhaps is the only downside of this type of surgery as making an incision in the throat can result in a host of psychological and health problems for the patient. These days, this surgery is reserved for patients whose apnea condition has turned life-threatening.
The other types of surgeries for sleep apnea are designed to correct anatomical abnormalities of the face which may contribute to apnea symptoms. They can be done either as a stand-alone procedure or along with UPPP. Such surgeries are:
- Genioglossus surgery aims to advance the tongue.
- Somnoplasty: This FDA-approved surgery uses the RFTA (Radio frequency tissue ablation) technology to shrink the volume of excess tissues in the nasal pathway. It is recommended to treat sn oring as well as nasal obstruction caused by deviated septum.
- Genioplasty: When the doctor needs to do plastic surgery of the chin.
- Hyoid advancement surgery: this surgery involves advancing the bone under the chin which also advances the tongue muscles.
- Maxillary or maxillomandibular advancement (MMA): This involves advancing the lower or upper jaw.
Recovery from sleep apnea surgery: life is a mixed bag
There is hardly any surgery that does not involve some amount of pain and discomfort during the recovery phase. Surgery for sleep apnea is no exception. But before you know what to expect, there are a few things you need to remember regarding your appointments with the surgeon after the surgery is complete.
- You should see the doctor 1 to 2 weeks after the surgery is done. In fact the future appointments should be schedule in the first, fourth and eighth to twelve weeks after the surgery. Such future appointment dates would normally be fixed even before you have entered the operation theater.
- Your doctor might recommend a second sleep apnea test after a month of surgery, primarily to assess the st ate of your health and whether there are any signals of a relapse.
- Be prepared for any emergency situation during the recovery period. It is wise not to wait for your next appointment if the following events occur:
– Nasal bleeding on the second day.
– Continuous high fever (more than 101.5)
– Blocked nose creating breathing distress.
– Painful ears and sore throat present even after the first couple of weeks.
– If there is no improvement of the earlier symptoms and snoring is unabated after a month.
– If no major improvement is noticed in the following 2 or 3 months.
Different outcomes from different surgeries
What the quality of life would be depends a lot on the type of surgery you have undergone. For example, after nasal surgeries there can be improvement of with perceptible improvement of snoring and lessening of daytime lethargy. However if you had undergone LAUP, the snoring problems may diminish but sleep apnea could still remain undiagnosed.
The Pillar Procedure assures fast recovery and reduced pain since this quick surgery (about 10 minutes) is usually performed in the outpatient clinic.
Walking that extra mile for quicker recovery
– Follow doctors’ instructions on diet. Soft diet is better. Also be prepared to be on liquid diet if the doctor deems this fit.
– Dehydration is common after most surgeries. Consume adequate fluids to ensure that you urinate at least once every 8 hours.
– The American Dental Association does not endorse the use of straws while sipping liquids.
– Exercise with caution. Talk to your doctor regarding what activities are allowed.
– Since doctors would invariably put you on sedatives, it is not safe to drive immediately after surgery.
– Keep control over your body weight.
– Do not lift heavy objects that are more than 20 lbs.
– There might not be any feeling on your teeth and you may lose your sense of smell.
But these are temporary situations which get rectified with time and proper medication.
– While it is better for the purpose of healing to swallow and talk, you need to avoid coughing and sneezing or talking in a loud tone.
Surgery for sleep apnea is usually the last and final option of treating the condition. Though the thought of surgery often creates alarm, there is nothing to worry, if your condition is diagnosed carefully and the surgery is performed by a qualified and experienced surgeon.