Sleep Apnea Surgery – A Guide For You

One of the recommended treatments for sleep apnea is surgery. If you or a loved one has been diagnosed with sleep apnea, it is best for you to learn all you can about the condition. In this article, learn about sleep apnea and your options if you choose sleep apnea surgery.

What Is Sleep Apnea?

In the simplest of words, sleep apnea is when you stop breathing during sleep. The brain controls your breathing without your permission which is why you don’t have to remind yourself to take a breath. The brain sends signals directly to your respiratory muscles causing you to breathe. When there is a problem with the brain or the respiratory muscles, sleep apnea occurs.

Types Of Sleep Apnea

Obstructive sleep apnea

This is the commonest type of sleep apnea. Here, there is a problem with the respiratory muscles. Usually, the problem is not due to a disease of the muscle per se, but an over-relaxation of the throat muscles.

When you sleep on your back, your throat muscles relax closing up the airway, keeping you from breathing. In this form, you CANNOT breathe because the airway is closed.

Central Sleep Apnea

This form is less common. The problem is with the respiratory control center in the brain. Here, the brain doesn’t send signals to the muscles to allow air into the lungs. In this form, you DO NOT breathe because there’s no instruction from the brain to breathe.

Central sleep apnea is usually caused by conditions that affect the brain especially the brainstem where the respiratory control center is located.

Mixed Sleep Apnea

This form of sleep apnea happens when both central and obstructive sleep apnea occurs together. Usually, it occurs during the treatment for obstructive sleep apnea using a CPAP (continuous positive airway pressure) device. Research is still ongoing about this form of sleep apnea.

I Have Sleep Apnea, What Next?

With a confirmed diagnosis of sleep apnea, you and your doctor should discuss your treatment options. There are three things to consider

Lifestyle changes– These are the things you can change that may improve your symptoms. These include Weight loss, avoid sleeping on your back, Smoking cessation, Limit alcohol consumption, Avoid sleeping pills.

Non-surgical therapy – These improve your symptoms without you having to go through surgery. Examples are Continuous Positive Airway Pressure (CPAP) and dental devices to keep the airway open.

Surgery- This could be an option, if your doctor recommends you have surgery, here’s what you should know

What Are My Options If I Choose Surgery?

Surgery is possibly curative of sleep apnea. However, there are various surgical options available at this time. It’s best to know all your options so that you can make an informed decision when choosing.

UvuloPalatoPharyngoPlasty (UPPP)

This is the commonest surgery for sleep apnea. This procedure is best for those who have soft tissue blocking the airway. The surgeon removes this excess soft tissue and may also remove your tonsils and uvula to create a bigger channel for airflow during sleep.

Nasal Surgery

This is another common surgery usually done for those who have the problem in their nose. Sometimes the septum can be deviated causing blockage or the turbinates (curved bones in the nasal passage) could be enlarged. A septoplasty may be done to straighten the nasal septum and the turbinates may be reduced. This opens up the airway which relieves the symptoms of sleep apnea.

RadioFrequency Volumetric Tissue Reduction (RFVTR)

This is done for people who have severe snoring. Radio waves are used to decrease the density of the soft tissue in the throat making them smaller. This allows for more space in the throat allowing air to flow freely.

Soft Palate Implants (also called ‘The Pillar Procedure’)

This is usually for mild cases of sleep apnea and those with bothersome snoring. Three polyester rods are inserted into the soft palate causing a reaction. This process depends on the body reacting to the foreign substance by inflammation which then heals and forms a scar. The scarred soft palate is shrunken and stiff so it doesn’t relax and block the airway while sleeping. Ultimately, this will reduce the snoring and the apnea.

Hypoglossal Nerve Stimulation

The hypoglossal nerve controls the tongue muscles. An electrode which stimulates this nerve is attached so that when you sleep, the tongue muscles still contract and keep the tongue from relaxing and blocking the airway.

Lingual Tonsillectomy

The lingual tonsils are way in the back of the throat. When these tonsils enlarge, they can cause sleep apnea by blocking the airway. The removal of these tonsils will open up the air passage and resolve the symptoms of sleep apnea.

Hyoid Suspension

The hyoid is a bone in the neck that the muscles of the tongue and pharynx attach. This surgery involves moving the hyoid bone forward by attaching it to the Adam’s apple or suspending it from the jaw bone. This creates more space in the airway and prevents the tongue from relaxing so much it blocks the flow of air. This surgery is good for those with a large tongue that is the culprit in causing sleep apnea. It is also minimally invasive.

Tongue Advancement (Genioglossus Advancement)

This procedure is usually combined with another like the UPPP or hyoid suspension. The genioglossus, a major tongue muscle, is brought forward by removing a portion of the bone it is attached to and re-attaching it with a titanium plate. This process of bringing the tongue forward keeps it from sliding back into the airway during sleep. This procedure works best for those whose obstruction is due to their tongue.

 Midline Glossectomy

A portion of the tongue at the back of the throat is removed to create room for air to pass. This process also reduces the soft tissue in the throat that may lead to sleep apnea.

Maxillo – Mandibular Osteotomy (MMO) and Maxillo – Mandibular Advancement (MMA)

These surgeries are slightly complicated and are therefore used for those with severe sleep apnea. The idea here is that the upper and lower jaws are cut and pulled forward. The adjusted jaw bones are then kept in place with titanium plates. This opens up the entire air passage allowing air to flow freely.  The downside of this procedure is that the teeth have to align perfectly so the surgeon would wire your teeth shut for weeks to allow for proper healing. This procedure is not commonly done.

Anterior Inferior Mandibular Osteotomy (AIMO)

Some cases of sleep apnea may be due to a small jaw or an abnormality in the bones of the jaw. In this surgery, the chin is split and brought forward just like in the MMA procedure above. This also opens up the airway and reduces the symptoms of sleep apnea. However, the success rate is not as high as in the MMA, so it is usually combined with another surgery to increase its efficacy.

Tracheostomy

This is the most invasive and aesthetically unappealing procedure which is why it comes last. It is the procedure of last resort. When all else fails, a tracheostomy usually would not fail. In this surgery, a hole is made in the neck to allow air flow directly into the lungs, cutting off all possible obstruction in the upper airways.

It may be used in morbidly obese people and those with craniofacial abnormalities in whom all other options have failed or the risk of attempting the procedure is too high. It is a highly effective but equally extreme option for sleep apnea.

Are There Complications Of The Surgery?

Just like with any surgery, there are always complications. The major complication of sleep apnea surgery is that you go through the process and it doesn’t work or it re-occurs. The success rate of the surgery is about 30%.

It can be disheartening and disappointing to go through the surgery and still come back to your doctor with the same complaint. In that case, your doctor would review you and maybe present another option to you. Whichever way it goes, don’t be disheartened. Keep working with your doctor until you find your solution.

Other complications include – bleeding, pain, infection and wound breakdown.

What If I Don’t Want Surgery?

Before surgery is suggested by your doctor, you probably would have already tried the non-surgical management of sleep apnea. Aside from the lifestyle changes as mentioned above, the two mainstays of therapy are

Positive Airway Pressure

This is device is attached via mask into the nose and/ or mouth and forces air into your throat while you sleep. The forced air keeps the airway from closing and ensures air gets into the lungs. This keeps you from having apnea and prevents the effects of sleep apnea.

The mechanism can be continuous (CPAP), two levels that change when you breathe in and out (Bi-PAP) or variable levels (VPAP). The most widely used is the CPAP and it is very effective.

Dental Devices

These are devices fitted by dentists that have expertise in sleep apnea. These devices keep the airway open ensuring the free flow of air through the mouth and throat. There are numerous devices available, so you need to speak with your doctor to find which may work best for you.

Both options may be used in combination for those with severe sleep apnea. But either one works spectacularly. The downside is that these devices have to be worn to sleep which may be uncomfortable for most people. Also, these devices don’t solve the problem; they only make breathing easier so they may have to be used for a very long time.

Sleep apnea is a common ailment that has many treatment options including surgery. However, to get the most out of your treatment, you have to choose the option that best suits you.

What Is My Risk Of Having Sleep Apnea?

You have an increased risk of developing any form of sleep apnea if you have any of the following factors and an even higher risk if you have any combination of factors.

  • Male
  • Obese or overweight
  • Above the age of 40
  • Large tongue and/ or small jaw
  • Enlarged tonsils
  • Large neck size (over 17 inches in men and 16 inches in women)
  • Family member with sleep apnea
  • GERD (Gastro-Esophageal Reflux Disease)
  • Frequent alcohol use
  • Smoking

Your risk for developing Central sleep apnea is increased if you have any of the following

  • Parkinson’s disease
  • Brain infection or tumor
  • Stroke
  • Use of narcotic painkillers
  • Heart diseases like Atrial fibrillation or Congestive heart failure
  • Undergoing treatment for obstructive sleep apnea. This can also cause a mixed sleep apnea.

What Signs Should I Watch Out For?

  • Really loud snoring
  • Waking up with a dry, parched throat
  •  Frequent breaks in breathing
  • Waking up from sleep gasping for air
  • Constant tiredness
  • Excessive daytime sleepiness  
  • Morning Headaches.
  • Restless sleep.
  • Depression or irritability
  • Loss of interest in sex

Are There Consequences Of Untreated Sleep Apnea?

Unfortunately, a lot of people are living with undiagnosed and untreated sleep apnea. They have declining work performance, waning health and constant tiredness. The risks of untreated sleep apnea far outweigh the time and effort needed to diagnose and treat the illness. Some of these consequences are

  • Increased risk of accidents
  • Depression
  • Diabetes
  • Hypertension
  • Heart disease
  • Stroke
  • Chronic headaches

How Is Sleep Apnea Diagnosed?

Sleep apnea is diagnosed after an interview and examination by your doctor, some tests, and a sleep study. A sleep study is necessary to diagnose sleep apnea. In the sleep study, the electrical activity in your brain is monitored while you sleep and compared to your breathing, blood pressure, eye movements and other vitals.

The results of this test help identify if you have sleep apnea or another sleep disorder. It also helps determine which type of sleep apnea you have. From this study, your treatment plan is then drawn up.

Dr. Oyinkansola Kolawole

Dr. Oyinkan has a degree in medicine and surgery. Her passion in life is to help people in all the ways she can including breaking down difficult to understand medical facts into simple and fun bits of information.

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