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Surgery Options for Obstructive Sleep Apnea

Going Under the Knife to Treat Sleep Apnea When CPAP Fails

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Updated February 19, 2014

Surgery Options for Obstructive Sleep Apnea
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For those who are unable to tolerate continuous positive airway pressure (CPAP) to treat their obstructive sleep apnea (OSA), what surgery options exist? There are a handful, but they may be of limited effectiveness and may not be for everyone.

Uvulopalatopharyngoplasty (UPPP)

This is the most common surgical treatment in individuals with mild and moderate OSA who cannot tolerate CPAP or other medical management. UPPP is the surgical removal of excess tissue in the upper airway, including the back of the mouth and the throat.

UPPP involves the removal of tissue from the tonsils, uvula, and the hard palate (the roof of the mouth). These tissues may be obstructing the airway, and it is hoped that removing them will clear this obstruction.

There are various complications that can occur with the procedure. As with any surgical procedure, there are risks of pain, bleeding, and infection. In addition, there may be changes in the voice, a narrowing of the pharynx (called stenosis), a sensation of a foreign body in the throat, or the risk of velopharyngeal insufficiency (regurgitation of food, liquids, or saliva into the nose when swallowing). There may also be difficulties tolerating CPAP if it is needed after the procedure.

Only 50% of adults treated with UPPP cut their number of apnea and hypopnea events by half or more. These improvements may also diminish over time. It is considered a second-line therapy, after CPAP treatment, and only for those who have tissue obstruction of their airway.

Other surgeries involving the soft palate can also be performed.

Tracheostomy

Tracheostomy is a surgical incision in the front of the windpipe (trachea), with placement of a plastic tube to keep this open, and it is highly effective in treating OSA. It bypasses the obstruction of the upper airway, which is the primary cause of the disorder.

Due to its rather invasive nature, and the effectiveness of CPAP, it is rarely used. It is generally reserved for those with life-threatening disorders such as cor pulmonale, arrhythmias, or severe hypoxemia (low blood oxygen levels) that cannot be controlled with other treatment.

Are There Other Surgical Options?

Depending on the cause of the apnea, genioglossus (tongue) advancement, hyoid (chinbone) myotomy with suspension, and maxillomandibular (jaw) advancement may be performed. All of these procedures correct anatomical defects related to the muscle and bones supporting the tongue and lower jaw, and they would not be performed in the absence of these defects.

Sources:

Cooper, D.H. et al. The Washington Manual of Medical Therapeutics. 32nd edition. Lippincott Williams & Wilkins. p. 260.

Sher, A.E. et al. "The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome" Sleep. 1996;19:156-177.

Li, K.K. et al. "Long-term results of maxillomandibular advancement surgery." Sleep and Breathing. 2000;4:137-139.

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