Treatment – Surgery
An operation may be an option if your health-care professional finds an obstruction in your airway or if more conservative treatments have not worked. Whatever type of operation is recommended, be sure you are aware of all possible risks and side effects before proceeding. While an operation can be an effective treatment for some patients, it is not the right choice for everyone. The goal of any surgical procedure to treat snoring or sleep apnea is to provide and maintain an open airway during sleep. Surgical procedures are site-specific, treating particular locations of the airway. Diagnosing the exact site before surgery is the key to a successful treatment. If successful, surgery corrects the problem permanently, unlike CPAP and Oral Appliance therapy which treat the problem - i.e. if the device is not used, snoring and/or sleep apnea will re-occur.
Surgical sites may include the nose (nasopharynx), the upper throat (oropharynx) and/or the lower throat (hypopharynx) and surrounding structures. Relapse should be discussed with the surgeon.
A nasal obstruction causes a patient to mouth breathe, especially during sleep. A nasal obstruction may eliminate the use of CPAP or oral appliances as a choice of treatment because a nasal obstruction can impair the effectiveness of CPAP or oral devices. Surgical procedures to clear the nasal airway are done to correct the results of a broken nose, turbinate hypertrophy, septal deformities, alar collapse and to remove any tumors or polyps in the nose. Although nasal surgery in and of itself has not been shown to be an effective treatment for obstructive sleep apnea, a clear and open nasal airway is very important for normal respiratory function and should be considered as the first phase of treatment.
Surgery can reduce the size of the soft palate and/or uvula.
- Uvulopalatopharyngoplasty (UPPP)
- UPPP requires hospitalization and involves removal of some of the uvula, soft palate and redundant tissue in the back of the throat. Approximately 50% of patients who undergo this operation are helped by it. Side effects such as severe throat pain, nasal-sounding speech, and the regurgitation of liquids into the nose when swallowing, have been reported.
- Laser assisted uvulopalatoplasty (LAUP)
- This procedure is for the treatment of snoring only. In LAUP the tissue of the uvula and soft palate are progressively removed in a series of office visits. Each treatment takes about 15 minutes and most people require two to three visits to stop the snoring. While this technique appears promising, patients need to be aware that its effectiveness in the treatment of sleep apnea has not yet been completely evaluated.
- Radio-Frequency Tissue Ablation (Somnoplasty)
- Radio frequency waves are delivered by a needle electrode placed under the surface of the tissue and causes a contraction of the excessive tissue that causes snoring. This office procedure is done to control snoring only.
More complicated and radical surgical procedures can help to change the tongue position and size, open the lower airway or reposition structures in the lower third of the face. These options are considered only as a last resort.
In extreme cases a tracheostomy can be performed to by-pass all collapsible structures of the nose or throat. Surgical treatment of obstructive sleep apnea began with the tracheostomy which enjoys a 100% success rate because it completely bypasses all the sites of upper airway obstructions. Even through a tracheostomy often results in immediate relief of symptoms it is poorly received by patients as many cannot accept the idea of a permanent opening in their throat or cope with the maintainance of that opening. A number of complications emerge with time. They are tracheal site infection, physiological problems, granuloma formation, chronic irritation, uncontrolled secretions, bronchial infections, and eventual stenosis. This treatment is an absolute last resort for only the most severe sleep apnea patients.