Sleep Apnea

Surgery for Sleep Apnea: Procedures That Can Make a Difference

For most people with obstructive sleep apnea (OSA), treatment begins with lifestyle changes, CPAP therapy, or oral appliances. But when those approaches do not provide enough relief, or when a person cannot tolerate them, surgery may be an option. Sleep apnea surgery works by removing or reshaping tissue in the upper airway to create more room for air to pass through.

Who Is a Candidate for Surgery

Surgery is generally considered for people with severe OSA whose symptoms have not improved significantly with non-surgical treatments. It may also be appropriate for people who cannot wear a CPAP mask due to discomfort or claustrophobia. To be a surgical candidate, a person must be healthy enough to tolerate the procedure. Significant obesity or serious heart or lung conditions may rule out surgery.

Common symptoms that may lead to a surgical evaluation include loud snoring with breathing interruptions, waking up out of breath, excessive daytime drowsiness, morning headaches, irritability, and difficulty with memory and focus.

Before recommending a procedure, a sleep specialist will evaluate the anatomy of the airway. This may include imaging scans or a nasopharyngoscopy, a procedure that uses a small scope to identify blockages in the nose and throat. A sleep study is also typically part of the evaluation.

Nasal Surgery

When the source of obstruction is in the nose, nasal surgery can improve airflow and make other treatments like CPAP or oral appliances easier to use. Common nasal procedures for sleep apnea include:

  • Endoscopic sinus surgery, which removes blockages and drains mucus in people whose OSA is related to chronic sinusitis
  • Nasal valve surgery, which stabilizes or corrects weak or collapsed nasal valves
  • Septoplasty, which straightens a deviated septum, the wall of bone and cartilage between the nasal passages
  • Turbinate reduction, which uses heat or cauterization to shrink inflamed tissue inside the nose
  • Distraction osteogenesis maxillary expansion (DOME), a four-step procedure that widens the upper jaw and palate

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    Mouth and Throat Surgery

    When weak or irregular structures in the mouth and throat are causing the airway to collapse, several procedures may help:

    • Hypoglossal nerve stimulation uses a surgically implanted device to stimulate the nerves that control the tongue, keeping the airway open during sleep
    • Uvulopalatopharyngoplasty (UPPP) removes or remodels tissue at the back of the throat, including the uvula, tonsils, adenoids, and part of the soft palate
    • Transoral robotic surgery (TORS) uses minimally invasive techniques to widen the airway without external incisions
    • Tongue reduction removes excess tissue at the back of the tongue
    • Partial epiglottidectomy removes part of the epiglottis, the flap of cartilage that can block the back of the throat
    • Transpalatal advancement pharyngoplasty corrects a collapsed soft palate by removing part of the hard palate to open the airway

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      Jaw Surgery

      A narrow jaw or throat increases the risk of OSA. Two procedures address this directly. Maxillomandibular advancement (MMA) moves both the upper and lower jaws slightly forward to widen the airway and prevent the walls of the throat from collapsing. Genioglossus advancement moves the lower jaw forward to stabilize the tongue and prevent it from blocking the airway during sleep.

      Weight Loss Surgery

      For people whose OSA is related to obesity, weight loss surgery may be an option. It does not directly change the structure of the airway, but reducing excess fat in the tongue, neck, and throat can make breathing during sleep significantly easier. In some cases, significant weight loss can partially or fully resolve OSA symptoms.

      What to Expect

      Sleep apnea surgery typically takes one to three hours. Some procedures are outpatient, allowing the patient to go home the same day. More complex surgeries may require a short hospital stay. Most procedures use general anesthesia.

      Recovery ranges from one to six weeks depending on the procedure. It may take several months to notice a significant improvement in sleep apnea symptoms. Some people continue using CPAP after surgery, though it is often easier to tolerate. Mild pain and some bleeding after surgery are normal.

      Risks

      Potential side effects of sleep apnea surgery include bleeding, infection, difficulty swallowing, changes to taste or smell, voice changes, numbness in the mouth or throat, nerve injury, and in rare cases tongue paralysis. A surgeon will review specific risks based on the type of procedure.

      Key Takeaway: Sleep apnea surgery is an option when CPAP and other non-surgical treatments have not worked. There are several types of procedures, targeting different parts of the airway including the nose, throat, jaw, and tongue. The right procedure depends on the anatomy causing the obstruction. Recovery takes weeks to months, and results can be significant for the right candidate.

      Source: Penn Medicine

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