If you’re suffering from sleep apnea, the go-to treatment is CPAP (continuous positive airway pressure) therapy. But there’s also a less common alternative—surgery. What types of operations are available to treat sleep apnea, are they effective, and why is CPAP treatment preferred in the majority of cases?
Types of Surgery
Ultimately, most procedures to cure sleep apnea focus on expanding the airway to eliminate the blockage that occurs when the throat relaxes during sleep. This can be achieved by removing throat tissue, rearranging bones around the windpipe, or even inserting a breathing tube into the neck. Some of the most common surgeries are detailed below.
- Removal of throat tissue (Uvulopalatopharyngoplasty or UPPP) This involves removing tissue from the back of the throat in order to enlarge the airway. Tissue removed can include the uvula (the flap dangling from the back of your throat), part of the roof of the mouth, the tonsils, and other excess tissue. It is the most common type of sleep apnea surgery, but is often paired with other operations.
- Removal of the tonsils and adenoids (Tonsillectomy and Adenoidectomy) Taking out the tonsils and/or the adenoids (a soft mass of tissue located just behind the uvula) is most commonly used on children. In kids with sleep apnea, this procedure is more effective than most sleep apnea surgery, with a 75% to 100% success rate.(However, this doesn’t mean that it doesn’t involve risk.)
- Shrinking the tongue and surrounding tissue using radiofrequency waves (Radiofrequency volumetric tissue reduction (RFVTR)) Directing energy waves at the soft palate and the base of the tongue can tighten and shrink the tissue.
- Palatal implants (also known as soft palate implants or the Pillar Procedure) Stiff polyester rods are inserted into the soft palate, which stiffens the tissue and prevents airway blockage when throat muscles relax.
- Moving forward the upper or lower jaw (Maxillomandibular osteotomy (MMO) and maxillomandibular advancement (MMA)) By advancing the upper and lower jawbones, the actual skeletal structure of the airway is widened. This requires making precise cuts to the jawbone, moving the jaw forward 10 to 12 mm, and using titanium plates to keep it in place. Frequently, patients must have their jaws wired shut after the surgery to permit them to heal. This operation does have a relatively high success rate of 90%, but is used infrequently because of its complexity.
- Inserting a breathing tube into the airway (Tracheostomy) This is used only as a last measure for very severe sleep apnea patients for whom no other treatments have worked. It involves opening an aperture in the lower neck and inserting hollow breathing tube. During the night, the valve is opened, permitting air to enter the windpipe and surpassing any sites of blockage.
- Other types of surgery Other options for surgically treating sleep apnea include nasal restructuring, moving forward the tongue, moving forward the hyoid bone in the lower throat, surgically removing part of the tongue, and weight loss surgery.
The Pros and Cons of Sleep Apnea Surgery
For some people, sleep apnea surgery is necessary if CPAP treatment does not work. Surgery can also be an advantage in that it removes the issue of sporadic CPAP compliance.
Unfortunately, surgery is much less effective than consistent use of a CPAP machine. When used frequently and correctly, CPAP is virtually 100% effective at eliminating the symptoms of sleep apnea. By contrast, a UPPP, the most common sleep apnea surgery, has about a 50% success rate. Operations tend to be most effective when the patient has some specific complication or feature than can be targeted surgically (for instance, children with large tonsils).
Clearly, use of a CPAP machine is also much less invasive than an operation and does not involve the risk of complications, side effects, and a recuperation period. Ultimately, surgery is used as a last resort.
If you have sleep apnea, make sure to talk to your doctor about what treatment is right for you.
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