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Sleep Apnea Surgery: Only When All Else Fails

While not nearly as common as it once was, sleep apnea surgery used to be the preferred type of treatment for the condition, and is still used at times for both obstructive and central sleep apnea. However, you first need to be aware of the risks concerning sleep apnea and anesthesia.



Sleep apnea is a condition where the airways are blocked during sleep, causing patient to struggle for air until they briefly wake up and their airways open again. People with sleep apnea most often do not remember the apnea, but wake up feeling tired, even after sleeping for many hours. 

Often the body compensates for this during the day, and sufferers will often find themselves not being able to stay awake in situations with no physical activity. Not only does the condition ruin the quality of sleep, it can cause a long line of health issues.

Often underlying causes are responsible for causing sleep apnea or making the condition worse. Having surgeries to get rid of these health issues will thus often cure the sleep apnea completely or at least lessen symptoms. 

Before resorting to surgery for sleep apnea, make sure you have tried all the available sleep apnea devices, that you have been to a sleep clinic for a diagnosis, and to a specialist, such as a sleep apnea dentist, to see if there aren't any other, non invasive options - for example, a custom made mouthpiece.

Sleep Apnea Procedures
  • Uvulopalatopharyngoplasty (UPPP)

sleep apnea surgeryA widely used sleep apnea surgery that prevents collapsing of the soft palate, tonsils, pharynx while sleeping - a condition that often causes the disorder. It is mostly used for patients with large tonsils, a large uvula, or a long, wide palate. 

Most commonly it is not recommended for people who are obese. The surgery is performed under general anesthesia. The tonsils and/or the uvula are removed and the palate is trimmed. UPPP surgery has a success rate of 50% -60% as a sleep apnea surgery.

  • Tonsillectomy

The surgical removal of the tonsils has been performed ever since 1000 BC. It is mostly used for children with frequent or permanent issues with tonsils, however, it is also sometimes recommended for adults that suffer from long periods of having an intensely sore throat. 

Tonsillectomy is a somewhat controversial type of surgery and many doctors disagree on how and when it should be used. Enlarged tonsils can cause sleep apnea by obstructing the airways somewhat or completely. So having a tonsillectomy will often improve the condition.

  • Nasal airway surgery

This type of surgery is often used for sinus issues, i.e. sinus headaches, blocked sinuses, or a deviated septum. Sinus issues are often connected with sleep apnea, so this type of surgery can help correct the problem.

  • Palatal implants

sleep apnea surgerySmall plastic implants are inserted in the soft palate, making it stiffer and more resistant. Often sleep apnea is caused by the soft palate relaxing and falling back during sleep, so the resulting scar tissue and stiffening of the palate can stop these problems from occurring. This surgery is called the Pillar Procedure.

  • Genioglossus advancement

This is a type of sleep apnea surgery where the tongue is pulled forward and its muscles attached to the lower jar. This fixes issues where a deformed or enlarged tongue prevents sufficient airflow during sleep. 

  • Tongue reduction

When a person has an abnormally large tongue it can fall back during sleep and obstruct air passage to the lungs. 

  • Bariatric surgery

Also called weight loss surgery, this is a type of procedure performed on people who are dangerously obese, for the purpose of losing weight. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by dissecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). Obesity is a major cause of sleep apnea and often losing weight will drastically improve the condition.

  • Hyoid suspension

The hyoid bone is situated in the neck. This horseshoe shaped bone works in combination with other bones and muscles to enable tongue movement and swallowing. Furthermore the hyoid bone helps keeping the airways open during the night. Sometimes pulling the hyoid bone forwards and attaching it to the thyroid cartilage, which is just below it, can ease or help to completely get rid of sleep apnea.

  • Maxillomandibular advancment (MMA) or orthognathic surgery

sleep apnea surgerySleep apnea can be caused by the structure of the jaw. If the upper or lower jaw or both are either too small or large it can cause the jaw to fall back and obstruct the airways when they are relaxed during sleep.  

Maxillomandibular Advancement or orthognathic surgery, also sometimes called Bimaxillary Advancement or Maxillomandibular are procedures, are surgeries where the upper and lower jaw are moved forwards, correcting jaw and receding chin issues. 

  • Tracheostomy

A type of sleep apnea surgery where a small, permanent opening is created in the neck, allowing air passage to the windpipe. The opening is closed during the day, where the patient is able to speak and breathe normally. During the night a valve is opened and air can enter the lungs without meeting the obstruction in the throat.

 

As you can see, there are many surgical options available for sleep apnea sufferers. First of all the cause of the obstruction is determined, i.e. soft palate, nose, excess fat. However, many doctors will only recommend them for sleep apnea specifically, when all other options have proven to be unsuccessful.

 

The most widely used treatment for the condition is a CPAP device, a type of mask that blows a positive pressure in to the mouth so that the airways can open fully. Some patients are not able to use these devices for various reasons, and it is these cases surgery is considered. 

The issue with sleep apnea surgery is that many of them have side effects; some more severe than others. Tonsillectomy, genioglossus advancement and tongue reduction can cause slurring of words; maxillomandibular advancement can cause the facial structure to change. 

Most surgical procedures in general can cause an abundance of issues, which is why doctors are often reluctant to do them. Before a procedure is determined the doctor will look at the severity and cause of the sleep apnea, and in most cases chose the least obtrusive option.

Some side effects of the various sleep apnea surgeries include:

  • Bleeding
  • Pain
  • Infection
  • Formation of scar tissue
  • Changes to voice
  • Difficulties swallowing


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