Is Throat Surgery for Sleep Apnea Right for You?
Without effective treatment, obstructive sleep apnea (OSA) increases the risk of heart disease, diabetes and stroke. The disorder is often addressed with lifestyle changes or CPAP therapy, which are generally effective in reducing the symptoms.
However, in those instances where less invasive treatments fail to reduce your symptoms, your healthcare provider may discuss surgical options with you.
Uvulopalatopharyngoplasty (UPPP) is the more common throat surgery for adults for sleep apnea, although there are other potential surgical procedures that could be discussed. The type of surgery will depend on individual circumstances and what is required to remove the obstruction that is causing your sleep apnea.
What Is UPPP Surgery?
UPPP surgery involves creating more space in the upper airways by removing or repositioning tissues. This prevents the collapse of excess tissue that is causing the blockage in your airways and the frequent breathing cessations experienced with obstructive sleep apnea.
The soft palate located at the back of the throat accounts for 90% of airway blockages when sleeping. However, a UPPP can involve several procedures depending on the specific tissue abnormalities of an individual. As well as the soft palate, the uvula, tonsils, adenoids and the roof of the mouth may require tissue removal or remodeling.
Examples of what may be involved in a UPPP include:
- Uvulopalatal flap – the uvula, which hangs down from the back of the throat, is folded beneath the soft palate
- Adenoidectomy – removal of the adenoids, tissues toward the back of the nose that helps protect against infection
- Tonsillectomy – removal of the tonsils, tissues located on either side at the back of the throat that also play a role in protecting against infection
- Palatal advancement pharyngoplasty – removal of part of the roof of the mouth to allow for a repositioning of the soft palate.
Throat surgery for sleep apnea is generally not necessary. If it is, a UPPP is largely a procedure for adults with obstructive sleep apnea.
Children experiencing sleep apnea usually have their tonsils or adenoids removed to address any breathing issues. As there is a lack of current research, a UPPP and other throat surgeries are not recommended during pregnancy.
Will UPPP Surgery Reduce My Sleep Apnea Symptoms?
A UPPP can be effective at reducing sleep apnea symptoms, with around 50% of those who undergo the procedure reporting a significant improvement in their breathing when sleeping.
Any reduction in breathing issues overnight will help with your sleep apnea, which in turn helps reduce your risk of the serious health complications linked to the disorder.
However, while many people who have throat surgery for sleep apnea notice marked improvements in their breathing, it is possible that your sleep apnea symptoms return. While surgery can ease your breathing difficulties by enlarging the airways, you may still also require CPAP going forward.
Further Procedures for Throat Surgery for Sleep Apnea
The following are further surgical procedures that may be considered to ease breathing as you sleep.
Maxillomandibular advancement
This procedure involves moving the jaw forward to enlarge the airways by creating more space behind the tongue. A study of 16 patients conducted in 2016 found that maxillomandibular advancement reduced the severity of the participant's sleep apnea by over 50%.
Genioglossus Advancement
This procedure reduces airway obstruction by moving the tongue forward through a slight tightening of the tendons at the front of the tongue. In doing so it helps stop the tongue from rolling back and obstructing the airways. This procedure is generally performed in conjunction with one or more other procedures.
Radiofrequency volumetric tissue reduction
This method uses radiofrequency waves to reduce excess tissue in the throat. Although more commonly used to treat snoring, it can still be a possible solution to treat obstructive sleep apnea for someone who can’t tolerate CPAP.
Hypoglossal nerve stimulator
A small electrode device is implanted onto the Hypoglossal nerve in the tongue. The device monitors your breathing as you sleep, and when it detects a breathing pause caused by an obstruction of the airways it stimulates the tongue’s muscles. This stimulation helps prevent the tongue from blocking the airways. However, early research indicates this procedure is less effective if you have a higher body mass index.
Septoplasty
A septoplasty straightens your nasal septum if it is crooked and affecting your breathing. The septum is the cartilage and bone structure that divides your nostrils.
Turbinate Reduction
This helps improve airflow by reducing the size of your turbinates, the bones that run along the inside of your nasal passage. When these bones are enlarged they can affect the flow of air to the lungs.
Hyoid Suspension
The hyoid bone sits toward the front of the neck and assists with the movement of the tongue. If the obstruction in the airways is centered toward the base of the tongue, moving the hyoid bone and surrounding muscles could free the blockage.
Midline glossectomy and base of tongue reduction
This procedure reports a 60% success rate, and possibly higher. It involves removing a portion of the base of the tongue to enlarge the airways and facilitate easier breathing as you sleep.
What to Expect Post-Surgery
While throat surgery can benefit sleep apnea patients, all surgery comes with an element of risk. However, by not treating obstructive sleep apnea you increase the risk of serious health issues like heart disease and stroke.
In the case of a UPPP, recovery can take up to three weeks. Swelling from the surgery may initially increase your sleep apnea symptoms and up to a third of people report swallowing difficulties. However, serious side effects are not common, and any that occur should clear after a few months.
Following throat surgery, your healthcare provider will monitor progress and may recommend a further sleep study to assess changes in your sleeping patterns and sleep apnea symptoms.
It must be stressed that less invasive treatments will always be tried first and that throat surgery for sleep apnea is generally unnecessary. However, if treatments like CPAP are not reducing your sleep apnea symptoms your health care provider may discuss the possible surgical options suitable for your condition.
Sources:
https://www.sleepfoundation.org/sleep-apnea/uvulopalatopharyngoplasty
https://www.healthline.com/health/surgery-for-sleep-apnea#risks
