Surgery for Obstructive Sleep Apnea

Obstructive sleep apnea is a debilitating condition that unfortunately affects many of us. Decreased airflow and oxygen delivery into the lungs causes disturbed sleep pattern, which then leads to inadequate sleep efficiency. Patients suffering from sleep apnea typically feel fatigued most of the day, and they have lack of sensation of energy and productivity. Furthermore, continued sleep apnea has been shown to lead to obesity, blood pressure, with further complications of heart attacks and strokes if the condition is untreated. Read more about Obstructive Sleep Apnea Disorder ››

The diagnosis of sleep apnea could only be done in a clinical setting. Refer to the Sleep Apnea diagnosis section of this website for more information on the diagnosis of sleep apnea.

Once the diagnosis of sleep apnea is confirmed, the treatment options include weight loss, CPAP mask, as well as surgery. In the appropriate patient with evidence of upper airway obstruction, surgery could be an effective tool for reducing the blockage concerns.

In most patients with obstructive sleep apnea, the obstruction is multifactorial. This means that there is not any one specific point where most of the blockage happens. Therefore, patients who choose surgery as a primary way of eradicating their sleep apnea concerns may need to have several concurrent procedures performed at various different areas of the upper airway anatomy in order to keep the passages open during deep sleep.

Septoplasty for deviation of the nasal septum is one of the more common surgeries performed for sleep apnea. The septum is the midline structure of the nasal passages, and serves as a “lane marker” to direct the flow of air from the nostril all the way to the lungs. The aim of septoplasty is to address any curvature of the bone or cartilage of the septum that is interrupting the smooth flow of air.

Another procedure that is typically performed at the same time is Turbinate Reduction. The turbinates are the side walls of the inner aspect of the nasal passages. In many patients with obstructive concerns, the turbinates are bulky and take up too much space. One of the most effective ways of reducing the bulk of the turbinates without causing too much damage to the normal physiology of the nose is to use the Coblation device. Using the Coblation handpiece, the bone of the turbinate is reduced in bulk. Other methods of addressing turbinate enlargement are cauterization, outfracture, laser reduction, etc.

Perhaps one of the more common procedures performed for all patients undergoing sleep apnea surgery is called Uvulopalatopharyngoplasty (UPPP). This addresses the deeper aspect of the palate and the uvula that separate the back of the throat from our breathing passages.

By using laser technique, the very distant end of the palate is trimmed, and the dependent portion of the uvula is excised. This usually allows for better airflow with much less blockage concerns. In my practice I also perform relaxing incisions around the area of the excision to further allow air exchange without blockage.

Most patients with obstructive sleep apnea tend to also have rather large tonsils. This will add to the bulk of flesh in the back of the throat, resulting in more blockage issues. It also tends to pull down on the palate with gravity, further complicating matters. Therefore, it is my preference to incorporate tonsillectomy in the appropriate setting for most patients opting for surgical treatment.

Additional procedures that we use in select patients with obstructive sleep apnea include reduction of the base of the tongue fullness with various methods, as well as various methods to changing the diameter of the pharynx to allow better airflow. It is best to consult your Ear, Nose, and Throat surgeon to find out if surgical treatment is a viable option, and if so which individual surgeries are recommended in each case.

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