Surgery for Sleep Apnea
What is sleep apnea?
Sleep apnea is a common breathing disorder that affects millions of people. Your throat has muscles that hold open your airway and allow you to breathe in and out. If you have sleep apnea, those muscles relax too much while you're sleeping. This makes the airway close. Your brain notices this, and wakes you up so you'll start breathing again. If this happens a lot, you won't sleep well, and you could feel sleepy and unable to think straight during the day.
Sleep apnea is serious. It can increase the risk for, or worsen, some medical conditions, and increase the chance of having an accident at work or while driving. In some cases, these effects of sleep apnea may be bad enough that your doctor will consider surgery to solve the problem.
What are the signs or symptoms of sleep apnea?
The most common signs of sleep apnea are loud snoring, choking or gasping during sleep, and being very sleepy during the day. You may also wake up with headaches or a dry throat, and have trouble concentrating during the day.
How is sleep apnea diagnosed?
Many people never know for sure if they have sleep apnea. Doctors usually can't detect it during routine office visits, and there are no blood tests for it. Most people who have sleep apnea do not really know it because sleep apnea only occurs during sleep.
Doctors diagnose sleep apnea by asking you questions about your medical history and your family's medical past, and performing a physical exam. Your doctor may also want to order a "sleep study" in which your breathing and sleep patterns are monitored.
How is sleep apnea treated?
The goal of treatment is getting you back to having regular breathing during sleep. Your doctor may recommend lifestyle changes such as losing weight or changing your sleeping position. He or she may also prescribe a mouthpiece that helps keep your airway open, or a breathing device that pushes air down your throat into your lungs. In cases where these other treatments don't work or if you have large tonsils, your doctor may want to send you to a surgeon to try surgery to fix the problem. It's important to keep in mind that no surgery works for everyone, and all have possible side effects.
The alignment of the bones and tissue in the jaw, mouth, and throat can cause sleep apnea. The most common surgical options rearrange, reduce, or totally remove the tissue in the throat that is blocking your airway while you sleep. This tissue can be in the soft palate, which is at the back of the roof of your mouth; the uvula ("that little thing that hangs down in the back of your throat"), your tonsils and adenoids, which are in the back of your throat; or your tongue. There are also surgeries to correct the alignment of the bones in the mouth, nose, and face. There is also a new treatment that stimulates your tongue muscles to prevent collapse in the throat.
Surgical treatments for obstructive sleep apnea include:
Uvulopalatopharyngoplasty (UPPP). In this surgery, the soft palate (at the back of the roof of your mouth) is trimmed or adjusted forward, and your tonsils and uvula may be removed. This is the most common surgery for sleep apnea, but its success rates vary depending on the size of your tonsils, palate, jaw, and tongue.
Hyoid suspension. If your airway is closing at the base of your tongue, your doctor may want to try connecting your hyoid bone (a U-shaped bone in the front of your neck) to the "Adam's apple" in your throat or suspend it from your mandible. This can help keep the airway open and prevent sleep apnea.
Hypoglossal nerve stimulator. In this surgery an electrode is attached to the main nerve that controls the tongue muscles. A pacemaker is used to stimulate the tongue muscle while you are sleeping to prevent collapse of the tongue and other tissues. This can keep your airway open and prevent obstructive sleep apnea.
Radiofrequency volumetric tissue reduction (RFVTR). This procedure uses energy waves, like in a microwave oven, to make the soft palate and tongue base smaller. Palatal radiofrequency tissue reduction is performed more for snoring than for sleep apnea.
Septoplasty and turbinate reduction. The septum is the bony divider inside your nose that separates your nostrils. Sometimes, when a person's septum is bent, it can block the flow of air. Septoplasty is used to straighten out a bent septum. Turbinates are curved bones along the walls of the nasal passage. They can block the flow of air and can contribute to sleep apnea. Reducing their size makes the airway bigger.
Lingual tonsillectomy. Along with the usual tonsils that are removed in a tonsillectomy, there is also tonsil tissue at the very back of the tongue. This can enlarge and contribute to airway obstruction. A lingual tonsillectomy can sometimes be done to open up the airway lower in the throat.
Midline glossectomy and base of tongue reduction. These two procedures make the airway bigger by removing part of the back half of the tongue. Newer techniques have been developed using radiofrequency energy to make these procedures easier to perform.
Genioglossus advancement (GGA). GGA is a procedure that was made specifically to open the breathing passage to treat sleep apnea. In GGA, the surgeon tightens a tendon in the front of your tongue, to keep it from sliding back and closing off the airway in your throat. In most cases, GGA is used with at least one other procedure, such as the UPPP or hyoid suspension.
Anterior inferior mandibular osteotomy (AIMO). In this surgery, the chin bone is divided to pull your tongue forward. This can help make your airway bigger and more stable. The good news is that you probably won't need to spend a night in the hospital, and your jaws don't need to be wired shut, but this procedure generally doesn't work as well as MMA. (See below.) Sometimes doctors perform AIMO by itself, and sometimes in combination with other procedures.
Maxillomandibular osteotomy (MMO) and maxillomandibular advancement (MMA). These surgeries are generally the most effective treatments for severe sleep apnea. Cuts are made into the bones of the jaws, and the upper and lower jaws are pulled forward. By doing this, the whole airway in your throat is made bigger to allow more air to pass through. Unfortunately, the surgery is complicated, and you'll have to stay in the hospital at least overnight. Also, the doctor may have to wire your jaw shut for several weeks to make sure it heals properly.
American Sleep Apnea Association.
Varieties of OSA Surgery
Weinberger PM, Terris DJ. Chapter 15. Otolaryngology—Head & Neck Surgery. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e. New York, NY: McGraw-Hill; 2010.
National Heart, Lung, and Blood Institute.
What is Sleep Apnea?
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/29/2014…#14623