Sleep Apnea Surgery

Sleep apnea (apnea from the Greek, meaning “without breath”) is a sleep disorder characterized by frequent pauses in breathing during sleep.  There are three types of sleep apnea, obstructive, central and mixed.  Obstructive is the most common, and is caused by anatomical blockage of the airway, and as such can often be treated by sleep apnea surgery. 

Sleep apnea surgery for obstructive sleep apnea consists of several different types of procedures:

1. Uvulopalatopharyngoplasty or UPPP, is the most common sleep apnea surgery for adults.  The procedure enlarges the airway by removing or shortening the uvula, (tissue that hangs from the roof of the mouth at the back of the throat).  The tonsils and adenoids, if present, are also removed as well as part of the soft palate (roof of the mouth).
2. Tonsillectomy and/or adenoidectomy is a sleep apnea surgery that removes the tonsils and/or the adenoids, often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
3. Tracheotomy creates a hole in the windpipe (trachea), and a tube is placed in the hole to allow air in.  This sleep apnea surgery, the most effective, is usually reserved for serious apnea sufferers when other treatments have failed.  The site around the tube must be cleaned daily to prevent infection.
4. Septoplasy is a sleep apnea surgery that straightens a crooked septum (the partition between the nasal cavities).
5. Laser midline glossectomy and lingualplasty are types of sleep apnea surgery that remove a portion of the tongue.
6. Maxillomandibular osteotomy or advancement (MMO or MMA) and two-part inferior sagittal mandibular osteotomy. are types of sleep apnea surgery which help enlarge the airway by moving the mandible (jaw) forward  These surgeries have high success rates, but last several hours, have a significant recovery period, and potential complications.
7. A relatively new procedure for sleep apnea surgery, performed in the physician’s office, is radio frequency ablation (RFTA), trade name Somnoplasty^TM.  Approved by the Food and Drug Administration (FDA) in 1998, it shrinks the size of the tongue and/ or palate.  Multiple treatments may be required, and can be used along with other sleep apnea treatments. 
8. The tongue suspension procedure (trade name Repose) is a different sleep apnea surgery procedure.  Approved by the FDA in February 1998, this sleep apnea surgery is intended to keep the tongue from falling back over the airway by inserting a small screw into the lower jaw bone and stitches below the tongue.  Usually performed in conjunction with other procedures, this surgery is potentially reversible.  No studies, however, on the long-term success are available, and little clinical data have been published to demonstrate the procedure’s  effectiveness. 

When considering sleep apnea surgery, be aware that effectiveness varies from person to person.  Physicians who perform sleep apnea surgery are most commonly otolaryngologists (specializing in the ears, nose, and throat) and oral and maxillofacial surgeons.  Referrals to a surgeon may be obtained through your family physician or through a sleep center.

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