A healthy night’s sleep is an integral component of our existence. Adults are urged to acquire at least seven hours of sleep each night as a result of this fact. If you don’t get enough sleep, you put yourself at increased risk for a variety of serious medical conditions, including diabetes, depression, obesity, and heart disease, amongst others.
Sleep apnea is one of the primary reasons why some people do not receive the recommended amount of sleep each night.
This serious sleep disorder manifests itself in the patient as frequent pauses in their breathing while they are asleep. The degree to which a person suffers from sleep apnea determines the type of sleep apnea they have.
On the other hand, obstructive sleep apnea is a condition that affects most people. It occurs when the muscles in your throat occasionally loosen while you are sleeping, which can cause your airway to get clogged and cause you to wake up feeling suffocated.
Although positive airway pressure therapy is the initial treatment option for moderate to severe sleep apnea, patient compliance remains an obvious issue. Studies have revealed that even in cooperative patients, the actual usage of PAP is only roughly 50% of the time.
Patients frequently express their dissatisfaction with their inability to wear a tight mask for the entirety of the night and with the high pressure of air that is forced into their noses. Surgery to treat sleep apnea may be an option for patients who are unwilling to comply with their treatment plan.
Even though there are a lot of different surgical possibilities, each patient’s operation needs to be customized to address the specific area of obstruction. The obstruction may be located anywhere in the upper respiratory system, including the throat, tongue, and nose.
Surgical Procedures For Treating Potential Source of Obstruction
The following is a list of the surgical procedures that are the most prevalent and successful in treating these potential sources of obstruction.
1. Nasal Surgery
Sleep-disordered breathing has been linked to both daytime nasal blockage and nocturnal congestion in the nose. As a result, addressing nasal blockage during sleep apnea surgery is critical.
An obstruction in the nose can be caused by the septum, turbinates, and nasal valve. In terms of nasal surgery, septoplasty and turbinate reduction are the most often performed procedures.
This is an outpatient surgery that is generally well-received by patients. In this procedure, a straightened septum and smaller turbinates are used. Because there is more room in the nasal cavity, the air is able to travel through it with more ease. Additionally, nasal valve collapse might occur in some cases.
This is because the lower nasal cartilages, which keep the nostrils open, are weaker than they used to be. Therefore, it is possible to reinforce and avoid valve collapse in people who have this problem by strategically placing the deviated cartilage taken from the septum.
2. Uvulopalatopharyngoplasty
Uvulopalatopharyngoplasty, or UPPP for short, has been the sleep apnea surgery that has been performed the most frequently over the course of the past quarter of a century. The soft palate and the pharynx can benefit from removing extra tissue with this technique. In addition, the tonsils are extracted if they are present.
After the tissue has been removed, sutures are inserted to prevent the region from closing in on itself and further maintain its wide open position. The oropharynx is a region of the upper airway commonly affected by obstructive sleep apnea, as it is a regular sight of obstruction in the vast majority of people with this condition.
As the recovery from this operation can be uncomfortable for up to a week, patients are required to spend the night in the hospital following the procedure.
Patients who snore benefit greatly from this operation since snoring is frequently caused by the reverberation of the soft palate against the rear wall of the pharynx. This technique provides patients with a significant improvement in their condition.
3. The Pillar Procedure
The Pillar Procedure is a method that requires only a small amount of surgical incisions and can help with snoring and minor sleep apnea. It entails inserting three polyester implants into the soft palate to get the desired effect.
A small hardening of the soft palate is caused by the implants, which are responsible for triggering an inflammatory reaction in the soft tissues that are located nearby. In addition, as a result of the relaxation of the muscles during the deep stages of sleep, the more rigid soft palate is less prone to make contact with the rear wall of the pharynx, which reduces snoring and apnea.
This operation can be carried out in the clinic under the influence of a local anesthetic while the patient is awake.
4. Hyoid Advancement
There is a little bone in your neck called the hyoid bone that connects the muscles of your tongue base and throat. Many people who suffer from sleep apnea have a wide base of the tongue.
The base of the tongue might contact the back wall of the pharynx, causing obstruction during the deep sleep stages because of the typical relaxation of muscular tone in this area.
In a relatively minimally invasive surgery, the hyoid bone is surgically moved anteriorly by attaching a suture around and suspending it from the front of the jaw bone. As a direct consequence of this, the patient’s airway does not become narrower, and the airway itself expands.
Two little incisions in the neck are all that are required for the treatment, which takes less than an hour to complete. As soon as possible after surgery, patients are able to return to their normal routines. As a result of its success, this surgery has become an essential part of the surgeon’s toolbox.
5. Tongue Advancement
The genioglossus muscle is moved forward during this surgery, which prevents the tongue from falling backward when sleeping. It’s necessary to cut through the jaw bone where the muscle attaches in order to progress the genioglossus muscle. The muscle is then connected to the bone as it moves forward.
A titanium plate holds the bone in place and prevents it from retracting back into the mouth. Numerous studies have indicated that this operation has a good success rate when addressing the same possible blockage areas as the hyoid advancement.
However, because it is more intrusive, this operation necessitates a hospital stay of at least one night. Next, a titanium screw is put into the lower jaw bone, and a plastic rope is connected beneath the front of the tongue to bring the tongue forward.
6. Tongue Base Reduction
As previously noted, the base of the tongue is a common location of the blockage in patients with OSA. Therefore, reducing the amount of tongue base tissue through various types of reduction is an efficient surgical method for decreasing apnea in addition to ‘advancement operations.’
Using radiofrequency waves is another option. An energy spike causes the tissue to shrink. The radiofrequency waves are focused on specific areas of the tongue base without inflicting any harm to the surrounding tissue. Although the operation is less invasive and can occasionally be done in the clinic with the patient awake, numerous treatments are required.
Direct excision of the tongue base can also be used to minimize its size. These procedures, termed a midline glossectomy, are used to remove the tongue base tissue by electrocautery or coblation. This is performed under general anesthesia in the surgery room and is similarly tolerated with minimal pain.
A modest but genuine danger of airway compromise necessitates that patients remain in the hospital overnight for observation. However, studies have demonstrated that all ways of reducing the tongue’s base are successful when used properly.
7. Lower Jaw Advancement
Obstructive sleep apnea is linked to abnormalities in the maxillofacial skeleton. Patients with sleep apnea often have narrower airways as a result of their smaller jaws, leading to nocturnal blockage. In order to expand the upper airway, maxillomandibular advancement expands the skeletal framework surrounding it.
Upper and lower jaw bones are mobilized and advanced up to 10-12mm throughout the process. Titanium plates support the forward position of the jaw bones. In order to perform this treatment, accurate bone incisions are needed, and the teeth must be positioned appropriately following the advancement.
For several weeks, patients’ teeth are wired shut to allow the bones to recover. Long-term success rates approach 90% despite surgery being unpleasant and necessitating many nights in the hospital. However, because of the higher surgical risks and potential consequences, this treatment is only performed by a few surgeons and medical institutes.
8. Tracheostomy
In order to provide air to the lungs, a tracheostomy is a procedure in which the trachea in the neck is surgically rerouted. As a result, the upper airway will be spared from any potential obstruction.
Obesity hypoventilation syndrome and major craniofacial abnormality patients who have failed all available non-surgical and surgical obstructive sleep apnea therapies may still be candidates for permanent tracheostomy. Although it may appear overkill, this is a highly successful surgical treatment for the terminally ill alone.
Risks of Sleep Apnea Surgery
There is a possibility of risk for patients who undergo sleep apnea surgery, just as there is the possibility of risk for patients who undertake any other kind of invasive surgery. These dangers can be broken down into two categories: those associated with health issues and those unique to particular operations.
1. Health Complications
Most research has been done on the chances of major health consequences associated with soft palate surgery. According to the findings, the probability of something bad happening is roughly equal to 1.2 percent.
However, it is essential to remember that people have a much-increased risk of experiencing these complications if they were already dealing with serious medical issues before undergoing surgery.
It is critical to have a discussion with your primary care physician and submit yourself to a complete physical examination before deciding whether or not to have surgery for sleep apnea. This will ensure that you are in good enough health to deal with the rigors of the procedure. It is possible that you will not be a suitable candidate for sleep apnea surgery if you are currently dealing with one or more major health concerns.
2. Procedure Specific Complications
Because these operations treat the structures of the throat, there is a possibility of consequences that are particular to the procedure itself. Some of these complications include difficulties with swallowing, speaking, tasting, and numbness or paralysis in the tongue.
There is also some debate on the effectiveness of surgery for sleep apnea. As is the case with other types of surgery, there is no assurance that this procedure will provide an effective and long-lasting solution.
When it comes to obstructive sleep apnea (OSA) surgery, various people have different experiences, and the results truly depend on a range of circumstances. On the other hand, some surgical procedures have been discovered to have a higher success rate than others.
Do some research and talk to your physician about the sleep apnea treatment that will work best for you and your specific case of the condition.
People afflicted with obstructive sleep apnea have access to a plethora of different surgical procedures to treat their condition. If more conventional treatments such as CPAP and BiPAP have been unsuccessful for you in the past, it may be time to think about undergoing one of the operations described above.
Always remember to schedule a visit with your primary care physician in order to have a conversation about the treatment options that might be appropriate for you.
Success Rate
The success rates of surgical procedures have been reported to range anywhere from 25 to 100 percent, with the majority of studies obtaining success rates between 50 and 70 percent. The likelihood of the surgical procedure being effective is impacted by the severity of the patient’s sleep apnea and physical characteristics.
Summary
After you’ve been diagnosed with sleep apnea and yet are having problems following the non-invasive therapies that have been suggested to you, you should discuss the matter with your primary care physician or a sleep specialist. In order to assess whether or not you are a suitable candidate for surgery to treat sleep apnea, they will interview you and conduct various evaluations.
Make sure you have a complete understanding of the potential outcomes of the operation before deciding to have it done. Do not be hesitant to ask your physician questions such as what kind of surgery they propose, how it will be conducted, what the success rate is, and how long it will be until you can resume your normal activities.
