Though there are numerous non-invasive treatment options for managing sleep apnea, surgery is often the last and final choice, performed when no other therapy seem to be feasible. Even in surgery for sleep apnea, there are plenty of options and the final selection is made by the surgeon depending on the severity of the condition, cause and nature of obstruction and of course the overall health condition of the patient.
No matter which type of surgery is chosen for treating sleep apnea, the main goal of such interventions is tissue removal from the nose or throat. These tissues vibrate or collapse and block the airway resulting in snoring and other apnea symptoms. Physicians who perform such apnea surgeries are usually otolaryngologists or ENT specialists and oral and maxillofacial surgeons.
Surgeries for sleep apnea: the main types
This surgery involves removing obstructive soft tissues located at the back of the throat causing blockage of the upper airway. Such tissues include the entire or part of the uvula, soft palate and the throat. During the surgery, if tonsils and adenoids are present they are also removed simultaneously.
UPPP aims to:
- Increase the dimension of the airway, at the site of throat opening.
- Stop some activities of muscles for keeping the airway open consistently.
- Improve the mobility of soft palate.
UPPP claims close to 65% success rate which may even out to about 50% over long term. The success of such a type of surgery is high if the cause of airway obstruction is related to abnormal function of the soft palate and not otherwise. It is also to be kept in mind that patients with moderate to severe sleep apnea might need CPAP assistance after the surgery.
Perhaps the biggest drawback of UPPP is the post-operative pain. Recovery too may take several weeks. Many of the post-surgical complications are serious, though very few experience them. They include: infection at the site of operation; sub-optimal functioning of the soft palate and throat muscles; accumulation of mucus in the throat; voice change; loss of sense of smell and more.
Relatively new, somnoplasty is another surgical procedure to treat sleep apnea that is approved by FDA for the treatment of habitual snoring. Doctors are increasingly performing this procedure for treating sleep apnea as well. One of the reasons for its gaining rapid popularity is the fact that somnoplasty does not require any hospital stay and can be done at the outpatient clinic of the doctors’ chamber. It is also minimally invasive and commands a high success rate.
Somnoplasty is based on the radio frequency tissue ablation (RFTA) technology. The procedure essentially aims to reduce the size of the soft palate and/or the tongue by burning the tissues with the help of a mildly heated electrode called the Somnus device. The procedure results in the stiffening of the tissues thereby reducing the volume of such tissues obstructing the air passage.
Many of the post-surgical complications are common to most ENT surgeries and quickly subside with proper medication. However, there are two major drawbacks to this type of surgery: the need for multiple procedures for getting the best results; and a lack of qualified somnoplasty doctors, possibly due to the procedure being relatively new.
Tonsillectomy is one of the oldest surgical methods for removing enlarged tonsils located on either side of the throat. Today this procedure is performed to treat sleep apnea. Some of the indications for which this procedure is performed include: recurrent acute tonsillitis or adenoiditis, nasal airway obstruction, snoring, obstructive sleep apnea and more. More often than not, adenoidectomy (removal of adenoids) is done along with tonsillectomy. To date, this procedure remains one of the most common surgeries in the US.
Post-operative bleeding is one of the biggest drawbacks of this procedure claiming 2 to 4% morbidity rate. 1 in 15,000 people die due to bleeding, obstruction in the air passage or use of anesthesia.
Other surgeries performed to treat sleep apnea are:
- Laser-Assisted Uvulopalatoplasty (LAUP)
- Pillar Palatal Implant
- Genioglossus (tongue advancement)
- Maxillary or maxillomandibular advancement (MMA)
- Laser midline glossectomy and lingualplasty (removal of part of the tongue)
- Hyoid myotomy with suspension
References & Resources:
- Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea: The Mayo Clinic Experience
- Modified uvulopalatopharyngoplasty for treatment of obstructive sleep apnea hypopnea syndrome
- Quality of Life Evaluation of Maxillomandibular Advancement Surgery for Treatment of Obstructive Sleep Apnea
- Outcomes of hyoid suspension for the treatment of obstructive sleep apnea