Surgical Interventions for Sleep Apnea

June 30, 2022

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More than 29.4 million individuals in the United States suffer from sleep apnea. Untreated sleep apnea can increase the risk of high blood pressure, stroke, type 2 diabetes, depression, and other serious health problems.6 Therefore, finding an effective treatment for a person’s sleep apnea is vital to improve their sleep and overall health.

Many people will find a treatment for their sleep apnea that does not involve surgery. If these options do not produce the desired result, however, it is critical that providers work with their patients to find a solution. Sometimes, surgical interventions may be considered. Here is what sleep apnea patients should know about sleep apnea and possible surgical treatments.

What Is Sleep Apnea?

Sleep apnea is a condition in which a person stops breathing periodically throughout the night as they sleep. The most common type of sleep apnea is obstructive sleep apnea, which occurs when the airway closes partially or completely, and breathing is hindered. The airway may become blocked by the tongue or collapsed tissue in the throat.6 A person with obstructive sleep apnea often snores, with periods of silence when they stop breathing. When they begin breathing again, there may be a gasp or choking noise.6

A less common type of sleep apnea is central sleep apnea. Central sleep apnea occurs when the body does not make an effort to breathe. It can occur as a result of a variety of health conditions, including heart failure, kidney failure, or stroke.4

Surgical Options

There are many treatment options for obstructive and central sleep apnea. Many of the choices are not invasive. Lifestyle changes, including exercise and weight loss, can be helpful.6 For some mild or moderate cases, dental appliances might be recommended.2,6 Some of the most common treatments involve using air pressure to keep the airway open as people sleep, including a continuous positive airway pressure machine (CPAP).6

When other treatments are unsuccessful or patients have a hard time using a CPAP machine, a doctor may recommend surgical methods to improve sleep apnea, such as the following:16

Palate and Throat Surgery

Uvulopalatopharyngoplasty (UPPP)  is a surgery that removes tissue from the palate and throat to expand the airway. This surgery can help people with obstructive sleep apnea. During this surgery, a surgeon will remove the uvula, part of the roof of the mouth, the tonsils and adenoids, and excess throat tissue.1 While this surgery can be effective, it may not eliminate the need for other sleep apnea treatments like a CPAP machine.6

Jaw Repositioning

Another option to treat obstructive sleep apnea is a surgery that changes the position of the jaw. Maxillomandibular advancement surgery adjusts the bones in the upper and lower jaw, as well as the attached airway muscles. The surgery increases the tension in the soft tissue of the throat and can improve airflow for patients.1 This procedure can be highly successful, especially for patients with structural problems in their jaw.1

Tongue Repositioning

Some people with obstructive sleep apnea can benefit from a procedure that changes the way their tongue falls as they sleep. With genioglossus advancement surgery, a piece of the lower jaw that is attached to the tongue muscle is pulled forward. The increased tension on the tongue results in a more firm tongue that does not collapse as much during sleep.5 This can reduce the blockage of the airway by the tongue.5

Tongue Surgery

Sometimes, an enlarged tongue can contribute to breathing difficulties for people with obstructive sleep apnea.5 The tongue may have greater muscle mass than normal or deposits of fat that increase its size.5 Additionally, the tongue has tonsils at the base that can become enlarged.5 If these factors make the tongue enlarged and impair breathing, a surgeon may remove portions of the tongue or the tonsils at the base of the tongue.

Nasal Surgery

Obstructive sleep apnea is characterized by closure or blockage of the airway in the throat that results in pauses in breathing during sleep.5 While the throat is a major factor in sleep apnea, the nasal cavity plays an important role as well. A doctor may recommend various nasal surgeries to help improve obstructive sleep apnea symptoms.

One procedure, endoscopic sinus surgery, can be performed to clear out mucus and blockages to treat chronic sinusitis.5 Another surgery, called a septoplasty, may be performed to straighten the bones and cartilage in the nose and remove blockages.5 Other surgeries can be performed to reduce enlarged structures in the nose or support nasal valves.

These nasal surgeries can improve airflow and help people breathe more easily. They can make sleep apnea symptoms better and make other sleep apnea treatments, like CPAP, more effective or easier to tolerate.5

Tracheostomy

A tracheostomy can cure sleep apnea, but it is not usually the first option.5 A surgeon will likely recommend a tracheostomy only if other treatments have not worked for a person with severe sleep apnea.6 When a tracheostomy is performed, a surgeon will make a permanent opening in the neck and put a tube into the windpipe.6 During sleep, a valve in the tube will be open to allow air to freely go into the lungs and bypass any blockages.6

Nerve Stimulation

While most surgical procedures for sleep apnea are designed to improve obstructive sleep apnea symptoms, both obstructive and central sleep apnea may benefit from nerve stimulation. During this procedure, a pacemaker-like device is implanted that stimulates a nerve.5 For obstructive sleep apnea patients, the device stimulates the hypoglossal nerve, which then stiffens the tongue and keeps it out of the airway.5 With central sleep apnea patients, the nerve stimulation targets the phrenic nerve, which controls the diaphragm. During sleep, the device stimulates the phrenic nerve when the body is not making an effort to breathe. The diaphragm then contracts and starts the breathing process.

When less invasive treatment options fail to improve sleep apnea, a surgical approach may be the best choice for people with severe obstructive sleep apnea.4

To learn more about sleep apnea and its symptoms, causes, and treatments, visit us at thevivosinstitute.com/blog

References
1.Caples, S. M., Rowley, J. A., Prinsell, J. R., Pallanch, J. F., Elamin, M. B., Katz, S. G., & Harwick, J. D. (2010). Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep, 33(10), 1396–1407. doi:10.1093/sleep/33.10.1396
2.Goyal, M., & Johnson, J. (2017). Obstructive Sleep Apnea Diagnosis and Management. Missouri medicine, 114(2), 120–124.
3.Ibrahim, B., de Freitas Mendonca, M. I., Gombar, S., Callahan, A., Jung, K., & Capasso, R. (2021). Association of systemic diseases with surgical treatment for obstructive sleep apnea compared with continuous positive airway pressure. JAMA Otolaryngology– Head & Neck Surgery, 147(4), 329–335. doi:10.1001/jamaoto.2020.5179
4.Muza R. T. (2015). Central sleep apnoea-a clinical review. Journal of thoracic disease, 7(5), 930–937. https://doi.org/10.3978/j.issn.2072-1439.2015.04.45
5.Sethukumar, P., & Kotecha, B. (2018). Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all. Breathe (Sheffield, England), 14(3), e84–e93. doi:10.1183/20734735.020118
6.Strohl, K. P. (2019). MSD Manual Professional Version: Obstructive Sleep Apnea. Retrieved May 25, 2022, from https://www.msdmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea