Surgery for Snoring and Sleep Apnea

Surgery for obstructive sleep apnea is designed to keep your airway open while you sleep. This is so you can breathe more easily. Snoring surgery works in the same way, although less-involved procedures are often used for snoring. Surgery can be used to open the nose or throat. There are many surgeries that open the space for breathing in the throat, and these are generally used if you cannot tolerate CPAP. CPAP is a machine that sends pressurized air through a face mask as you sleep. Talk with your sleep surgeon to understand your choices. Please continue reading to find procedures that may be advised recommended for you. 

Drug-Induced Sleep Endoscopy (DISE)

Different patients have different causes of their obstructive sleep apnea. A careful physical examination in your surgeon’s office while you are awake can be very helpful, as your surgeon can look inside your nose and throat with a thin flexible fiberoptic telescope to see where your breathing passages may be narrow. In Drug-Induced Sleep Endoscopy, the same type of flexible fiberoptic telescope is used, but the difference is that you will be sedated during this procedure in a way that may be similar to sleep. The goal is to see what might be causing your sleep apnea in conditions that are closer to sleep than being awake in the office. This procedure is performed in the operating room or a procedure suite room because patients receive sedation.

Nasal Surgery

Problems in the nose can make snoring or sleep apnea worse. They can also make a CPAP or an oral appliance mouthpiece harder to use. If blockages in your nose are severe, surgery can improve breathing. Nasal surgery can reduce the size of or straighten structures in your nose and remove any polyps or overgrowths. Nasal surgery can improve breathing through nose to make other treatments like CPAP or an oral appliance mouthpiece more comfortable and work better.

Risks of Nasal Surgery

• Bruising

• Bleeding

• Damage to or hole in the septum or thin wall between nasal passages

• Dryness in nose of nasal surgery

Soft Palate Surgery, including Uvulopalatopharyngoplasty (UPPP)

This is the most common surgery for sleep apnea. Uvulopalatopharyngoplasty surgery of the soft palate, or the back of the roof of your mouth. There are many different kinds of techniques that can remove, shrink or move tissue of your soft palate and remove your tonsils (if you have not had this done). Different techniques may be better for different people, so you should discuss the type of soft palate surgery that might be best for you with your sleep surgeon. Uvulopalatopharyngoplasty is performed in the operating room, and it requires general anesthesia (being asleep for the procedure). Patients often stay overnight in the hospital, but most people go home within 24 hours after surgery.

Risks of Soft Palate Surgery

This surgery usually causes substantial pain for the first 2-3 weeks after surgery, especially in adults who have their tonsils removed at the same time. Like any surgery, there are other risks that include:

• Bleeding

• Trouble swallowing, including having liquids or food going up into the back of the nose

• Scarring

• False feeling that something is in your throat

• Changes in speech (rare)

Radiofrequency Ablation (RFA) of the Soft Palate or Tongue

Radiofrequency uses heat to tighten soft tissues, and it can be used to treat the soft palate, tonsils or tongue. Soft palate radiofrequency is usually used for snoring, but not sleep apnea. Tongue radiofrequency ablation can be used for snoring or sleep apnea.

Risks of Radiofrequency Ablation (RFA)

• Mouth ulcer

• Swelling in airway

• Trouble with speech or swallowing

• Infection

 Tongue Surgery

In many patients, the tongue can fall back to block the space for breathing during sleep. There are many kinds of tongue surgeries that can stop this from happening. These surgeries can involve removing, shrinking or repositioning tissue. You should discuss with your sleep surgeon whether this type of surgery might be helpful for you, and what your risks are.

 Hypoglossal Nerve Stimulation

Another approach to treating sleep apnea uses stimulation of the nerve that controls tongue movement (hypoglossal nerve). Surgery includes placing a nerve stimulator system in your body so that it can stimulate your hypoglossal nerve as you sleep. Stimulation of the nerve moves your tongue forward while breathing, and it can also treat other structures (like the soft palate) that can cause obstructive sleep apnea. Hypoglossal nerve stimulation involves surgery, then working closely with your sleep medicine team to make sure that the system is working properly for you. You should discuss with your sleep surgeon whether this treatment might be helpful for you and also review the risks.

Jaw Surgery

If your upper or lower jaw sits too far towards the back of your throat, this can narrow the space for breathing and increase your risks of obstructive sleep apnea. Jaw surgery can move your upper or lower jaw forward to open the space for breathing.

Risks of Jaw Surgery

Jaw surgery has important risks to consider. Your sleep surgeon can tell you more about this. These risks include:

• Poor healing and possible additional surgery

• Tooth injuries and possible loss of teeth

• Need for orthodontic treatment (such as braces) to realign teeth

• Loss of feeling in jaw or teeth

• Change in facial appearance
  
  

Be sure you understand the risks and benefits of all procedures for snoring and sleep apnea.