'Sleep apnea surgery'
Surgery for sleep apnoea
There is no single surgery or procedure that can treat all sleep apnoea.
Everyone is different.
In most cases a multi-level surgical approach is required and our team go to great lengths to ensure the right operation is offered to the right patient.
Each individual patient case is the complex interplay of multiple areas of airway collapse and airflow dynamics. A particular operation might control one person’s OSA very well, but be completely ineffective in another.
Expected outcomes of surgery for sleep apnoea
The goals for sleep apnea surgery are multidimensional. We want you to feel better, and reduce the risk untreated obstructive sleep apnoea has on your overall health. Expected outcomes of sleep surgery operations include:
Minimise the symptoms and risk of obstructive sleep apnea
In patients where more conservative approaches have failed or are unacceptable to the patient, sleep apnoea surgery remains a sound option in the treatment of obstructive sleep apnea or OSA.
During your consultation, we will discuss the goals and expected outcomes of the sleep apnoea operation at length with you before proceeding.
Where surgery for sleep apnoea is chosen as the treatment option, we aim to reduce the medical risks of untreated sleep apnoea and relieve the impact of symptoms experienced, helping patients sleep better.
Facilitate the use of CPAP machine and maxillomandibular advancement splint (MAS)
Sleep apnoea surgery isn’t only recommended to reduce the risks of sleep apnoea.
In some cases, the sleep apnoea operation may be targeted to help patients learn how to use equipment such as a CPAP machine or maxillomandibular advancement splint (MAS) to successfully manage their obstructive sleep apnoea.
Goals of sleep apnea surgery
Minimise health risks
Untreated moderate to severe OSA can lead to severe health outcomes including premature death.
Fatigue associated with untreated OSA can severely impact quality of life and ability to function.
Facilitate other treatments
Treating OSA surgically facilitates the use of devices such as CPAP and MAS for improved reduction of health risks.
Sleep apnoea surgery
Every obstructive sleep apnea patient experiences a complex interplay of multiple areas of airway collapse and airflow dynamics.
While a specific sleep apnoea surgery might control one person’s OSA very well, the surgical option could be completely ineffective for someone else whose sleep is disordered.
In most cases, a multilevel surgical approach is required to adequately treat obstructive sleep apnoea and its symptoms. Some surgical treatments may be combined and performed all at once, other procedures may be staged with a delay between each procedure.
Providing a detailed clinical history combined with a sleep study and physical assessment will help define the most appropriate surgery for obstructive sleep apnoea.
Types of surgery available for sleep apnoea
Nasal and sinus surgery
In general, surgical treatment of the nasal airway alone is unlikely to have a significant impact on the effects of sleep apnea or sleep study scores.
However, surgery may have significant positive outcomes in the relief of symptoms and form part of a multilevel approach to surgery that can help facilitate the use of other devices, and improve the efficacy of palate and tongue surgery. Nasal surgery options usually include one or a combination of the following procedures:
- Correction of the deviated nasal septum (septoplasty)
- Inferior turbinate surgery (turbinoplasty)
- Removal of nasal polyps/opening of sinus drainage pathways (functional endoscopic sinus surgery: FESS)
Surgery to the soft palate (and potentially hard palate) is the most common form of sleep apnoea surgery performed in adults.
Removal of the tonsils (if still present) in combination with a form of pharyngoplasty (which refers to a soft palate repositioning operation) is the mainstay of palate surgery for sleep apnoea. There are a multitude of different techniques that can be used to better position the soft palate, depending on each individuals anatomy and patterns of airway collapse. The overall aim is to limit airway narrowing and lessen snoring producing vibration.
There are many variations of these surgical treatments but the most commonly used in our practice is the modified Uvulopalatopharyngoplasty or mUPPP.
Traditional sleep apnoea operations involved resecting or lasering significant amounts of soft palate tissue which can leave troublesome and unpredictable scarring. The mUPPP is an airway reconstruction procedure where no tissue is resected (except for tonsils and minimal amounts of palate fat). The palate is repositioned to a more favourable position which creates a more patent airway with less collapse and reduces the intensity of snoring.
In more severe cases of sleep apnoea, we may not be able to get enough treatment effect from repositioning the palate soft tissues alone. In this setting, an operation termed Transpalatal Advancement (TPA) may be offered. This surgical treatment involves mobilising a segment of the hard palate through the mouth and advancing it forward to further optimise the palate position.
Palatal surgical procedures include:
- Modified Uvulopalatopharyngoplasty (mUPPP)
- Variations of mUPPP depending on anatomy
- Transpalatal Advancement (TPA)
- Other skeletal surgery
Tongue/ Tongue base surgery
Obstruction at the tongue and tongue base is another level of potential obstruction in sleep apnoea.
Tongue/Tongue base surgery is usually administered as a combination of other sleep apnoea surgery options or minimally invasive procedures.
In some cases, the tonsil tissue at the base of the tongue (lingual tonsil) is large and obstructive and can be removed in a minimally invasive manner. In others, the actual bulk of the tongue muscle itself is the cause of the problem. This is a harder cause to treat and tongue reduction surgery may need to be considered.
In very rare circumstances the obstruction may be caused by tissues in the upper part of the voice box (larynx) such as the epiglottis or surrounding mucosa. Surgery to this area is also an option in selected cases.
Tongue/Tongue Base surgical procedures include:
- Lingual tonsillectomy
- Midline glossectomy (tongue reduction surgery)
- Tongue suspension surgery (rare)
- Surgery to epiglottis/supraglottic airway (rare)
Sleep apnoea surgery has advanced significantly in recent years. One of the most recent advances in surgical treatment is the development of implantable nerve stimulators.
There are several of these devices available worldwide, each with subtle differences in the way they function. The device is implanted into the neck and stimulates bringing the tongue forward while the patient sleeps.
This minimises collapse of the upper airway and improves airflow. While these devices aren’t yet commercially available in Australia, the data from clinical trials is very promising and this sleep apnoea surgery will be available at Melbourne Sleep Surgery as soon as it is approved.
Successful surgery for sleep apnoea often requires a multilayered approach. With surgical options developing continually and the best surgical options varying between patients, please contact us today to discuss the types of surgery for sleep apnoea available to you.
Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.