Surgery for Sleep Apnea: Procedures That Can Make a Difference

Sleep apnea is a common condition that causes breathing to repeatedly stop and start during sleep. While many people manage the condition with CPAP machines, oral appliances, or lifestyle changes, surgery becomes an option when those methods prove ineffective or aren't well tolerated. For some, surgical treatment can significantly reduce symptoms or even eliminate sleep apnea altogether.

The decision to undergo surgery typically depends on the severity of the condition, the cause of airway obstruction, and the patient’s overall health. Most surgeries target anatomical issues that contribute to airway blockage—such as excess tissue in the throat, nasal structure problems, or jaw alignment.

When Is Surgery for Sleep Apnea Considered?

Surgical intervention is usually considered when:

• CPAP or other non-invasive treatments are not effective or well-tolerated
• Anatomical abnormalities (like enlarged tonsils or deviated septum) are present
• The patient has moderate to severe obstructive sleep apnea
• Non-surgical efforts, such as weight loss or positional therapy, have not resolved the symptoms

Before recommending surgery, a sleep specialist may order a sleep study and imaging tests to pinpoint the site of obstruction and assess its severity.

Common Surgical Options for Sleep Apnea

Uvulopalatopharyngoplasty (UPPP)

This is one of the most frequently performed surgeries for obstructive sleep apnea. UPPP removes or reshapes tissue from the throat, including the uvula, soft palate, and sometimes tonsils, to widen the airway. It can help reduce snoring and apnea episodes, especially in patients with soft tissue obstructions.

Inspire Therapy (Hypoglossal Nerve Stimulation)

Inspire is a surgically implanted device that works like a pacemaker for the tongue. It stimulates the hypoglossal nerve to move the tongue forward during sleep, preventing it from blocking the airway. This option is generally recommended for those with moderate to severe sleep apnea who cannot tolerate CPAP.

Maxillomandibular Advancement (MMA)

MMA surgery repositions the upper and lower jaws forward to enlarge the airway. This procedure is more invasive but can be highly effective, especially for patients with skeletal abnormalities contributing to airway obstruction. It’s often recommended after other surgeries have failed or for people with severe OSA.

Genioglossus Advancement (GA)

This surgery targets the tongue muscle by pulling it forward to reduce the risk of it collapsing into the airway during sleep. GA is often performed alongside other procedures like UPPP or hyoid suspension.

Nasal Surgery

While not a complete cure for sleep apnea, nasal surgeries can support other treatments by improving airflow. Common procedures include:

• Septoplasty: Straightens a deviated septum to improve nasal breathing
• Turbinate reduction: Shrinks swollen nasal structures that obstruct airflow
• Nasal valve repair: Addresses structural weaknesses in the nasal passages

Tonsillectomy and Adenoidectomy

Primarily performed in children, this procedure removes enlarged tonsils or adenoids that block the airway. For pediatric patients, it’s often the first line of treatment and can result in a complete resolution of symptoms in many cases.

Recovery and Effectiveness

The recovery time from sleep apnea surgery depends on the procedure performed. For instance, UPPP typically involves a few weeks of throat discomfort and dietary modifications, while Inspire therapy recovery is faster and less painful. Jaw surgeries like MMA have a longer recovery period but may offer more lasting results.

Success rates vary depending on the procedure, patient anatomy, and severity of the condition. Surgical treatments tend to be more successful in younger patients, those with localized obstructions, or individuals with low body mass index (BMI). In some cases, a combination of surgeries may be recommended to achieve the best results.

Potential Risks and Considerations

As with any surgery, procedures for sleep apnea carry some risks. These may include:

• Pain and discomfort during recovery
• Swelling or bleeding at the surgical site
• Infection or complications from anesthesia
• Changes in speech or swallowing (especially after throat surgeries)
• Incomplete resolution of symptoms or recurrence over time

A thorough evaluation by a sleep medicine specialist and ENT surgeon is essential to determine the right surgical approach and set realistic expectations.