Tracheostomy for Sleep Apnea: Benefits and Risks

tracheostomy

Obstructive sleep apnea results from an obstruction in the airways during sleep. This can cause frequent breathing pauses that force the body to briefly wake for air. This may happen more than 30 times every hour in severe cases.

Sleep apnea can be managed to reduce the symptoms and help improve crucial restorative sleep. Treatment plans depend on the cause of sleep apnea and the severity of the disorder, and can involve lifestyle changes and positive airway pressure (PAP) therapy.
However, for a patient with severe obstructive sleep apnea where other treatments have not worked, a tracheostomy for sleep apnea might be considered.

What Is a Tracheostomy?

A tracheostomy is a surgical procedure in which a small permanent opening is made through the neck into the trachea. A tube is inserted into the opening to allow air to enter the trachea and lungs.

A tracheostomy is performed to help a patient struggling to breathe due to an obstruction in their airways. A tracheostomy for sleep apnea might be considered when other treatments fail to keep the airways free of obstruction when sleeping.

How Does a Tracheostomy for Sleep Apnea Work?

Obstructive sleep apnea is the most common form of the disorder. It is caused when excess neck tissue collapses into the airways to create a blockage when you sleep.

A tracheostomy for sleep apnea bypasses this blockage. The tube inserted into the trachea allows you to breathe air into the lungs and prevent breathing difficulties caused by blocked upper airways. Without the breathing pauses, your sleep apnea symptoms should reduce or be removed.

Since obstructive sleep apnea is a disorder that affects nighttime breathing, a valve is used to help control your breathing at night specifically. The valve is closed during the day to allow you to breathe and talk normally.

At night, before you go to bed, you can open the valve to allow air to bypass any blockage that may occur in the upper airways while you sleep. This ensures constant airflow to the lungs, removing the need to frequently wake for air, and preventing the daytime fatigue and sleep deprivation caused by obstructive sleep apnea.

Is a Tracheostomy for Sleep Apnea a Typical Treatment?

No, a tracheostomy is not a typical treatment for sleep apnea. It's viewed as a solution when other options have failed or were not appropriate for treating your symptoms.

Other treatments tend to work well for most sleep apnea patients, including the use of PAP devices which deliver pressurized air through a mask worn while you sleep to prevent the airways from collapsing.

Continuous positive airway pressure (CPAP) therapy is the most commonly used PAP device and is generally the first treatment option for severe obstructive sleep apnea. CPAP, BiPAP and APAP devices deliver air at optimal pressures to keep your airways clear and reduce the apneas experienced (the frequency of breathing episodes caused by an obstruction in the airways).

Benefits and Risks of a Tracheostomy for Sleep Apnea

While a tracheostomy for sleep apnea holds the potential for major benefits, any surgical procedure carries certain risks.

Benefits
The major benefit of a tracheostomy is that it could eliminate your sleep apnea symptoms.

Sleep apnea is a debilitating disorder where symptoms include frequent waking during the night for air, snoring, daytime sleepiness, poor concentration, morning headaches, and mood swings. Sleep apnea can have a huge impact on quality of life.

Without treatment, sleep apnea also increases the risk of developing serious health conditions including heart disease, high blood pressure, stroke, and diabetes.

A patient with severe obstructive sleep apnea, where you can wake for air over 30 times every hour, may therefore benefit from a tracheostomy when other treatment types fail to reduce their sleep apnea symptoms.

A tracheostomy might be recommended by a healthcare provider when it is seen as a viable option to help prevent the increased risk of the serious health issues linked to sleep apnea when other treatment options have not worked.

Risks

There are health risks in addition to emotional risks that need to be understood and weighed against the benefits. Your healthcare provider can talk you through the risks in detail.

The main risks of a tracheostomy for sleep apnea include:

  • infection around the opening and tube insertion point
  • bleeding
  • damage to the trachea
  • scar tissue forming where the opening in the neck was made
  • difficulties with speaking
  • increased risk of lung infections
  • emotional issues related to lifestyle changes required and appearance

Post-Surgery

A tracheostomy is often performed under general anesthesia. How long you stay in the hospital after surgery will depend on the speed of your recovery and will be closely monitored by the medical staff.

There will be an adjustment period as you become used to the different feel when you breathe and talk. Some people can find speaking particularly difficult in the days following a tracheostomy and may need help from their doctor or a speech therapist.

Any stitches will be removed after a week or so. It is also possible that the tube may be replaced with a new one between five and ten days after the procedure.

Keeping the tube clean once you return home is important, as this will help reduce the risk of infection. If you spot any signs of infection, such as swelling and redness, you should contact your healthcare provider straight away.

A tracheostomy for sleep apnea is performed to ensure uninterrupted breathing as you sleep. Therefore, during the day the valve on the tube will be closed, allowing you to talk and breathe as you normally would. It is only when you sleep that the valve needs to be open.

In summary, a tracheostomy for sleep apnea is not a typical treatment plan, but might be considered when other options like PAP devices have not been successful. This procedure can eliminate sleep apnea symptoms, but there are risks including infection, bleeding, speech difficulties, and self-image issues relating to the tubing. Careful consultation with a professional will help you to weigh up the potential benefits.