What is sleep apnea surgery?
Sleep apnea surgery is a procedure to make breathing easier for people with severe obstructive sleep apnea (OSA). OSA occurs when your upper airway collapses and restricts airflow while you sleep. Sleep apnea surgery removes or reshapes tissue in your upper respiratory tract (mouth, nose, and throat) to create more room in your nasal cavities and throat for air to pass through.
Obstructive sleep apnea surgery offers a variety of benefits, including better sleep quality, reduced snoring, and less daytime fatigue. It can also reduce your risk of complications related to OSA such as heart problems and stroke.
At Penn Medicine, we offer comprehensive sleep apnea care that includes non-surgical therapies as well as the latest surgical procedures. Sleep medicine specialists and otorhinolaryngologists (ear, nose, and throat specialists) work together to diagnose the underlying cause of your condition and select the right treatment for your needs. If OSA is disrupting your nights and days, we can help you find relief from symptoms and get the rest you need.
Sleep apnea surgery options
There are several types of sleep apnea surgery. At Penn Medicine, we offer complex procedures that may not be available at other programs.
The best procedure for you depends on your unique anatomy and the source of your breathing issues. Sleep apnea specialists at Penn Medicine do thorough evaluations that may include imaging scans or nasopharyngoscopy (an exam that uses a scope to find blockages in your nose and throat). We also do sleep studies at our state-of-the-art sleep centers located throughout the region.
Nasal surgery increases the size of your nasal passages and improves airflow in your nose. After nasal surgery for sleep apnea, it may be easier for you to use a continuous positive airway pressure (CPAP) device or oral appliance. Types of nasal surgeries for sleep apnea include:
- Endoscopic sinus surgery: removes blockages and drains mucus for sleep apnea related to chronic sinusitis
- Nasal valve surgery: stabilizes or corrects weak or collapsed nasal valves (narrow walls in your nose that regulate airflow)
- Septoplasty: straightens a deviated septum (crooked wall of bone and cartilage between your nasal passages)
- Turbinate reduction: uses heat or cauterization to shrink inflamed tissue around your turbinates (bony structures in your nose)
- Distraction osteogenesis maxillary expansion (DOME): widens your upper jaw and palate (roof of your mouth) in a four-step procedure using expanders
You’re at a higher risk for OSA if your jaw or throat is narrow or small. OSA can also be related to pharyngeal collapse, a condition in which the walls of your throat collapse when you breathe in. During a procedure called maxillomandibular advancement (MMA), we move your upper and lower jaws forward slightly to widen your airway and prevent the walls of your throat from collapsing. Or, we may perform a genioglossus advancement. This procedure moves your lower jaw forward to stabilize your tongue so that it doesn’t block your airway when you sleep.
Weak or irregular structures in your mouth and throat, such as your tongue or epiglottis (flap of cartilage beneath your tongue), can cause OSA. Procedures to correct these issues may include:
- Hypoglossal nerve stimulation: a surgically implanted device stimulates nerves that control your tongue, helping your airway to stay open while you sleep
- Partial epiglottidectomy: removes part of your epiglottis to open the back of your throat
- Tongue reduction: removes excess tissue at the back of your tongue
- Transoral robotic surgery (TORS): uses minimally invasive techniques developed at Penn Medicine to widen your airway without external incisions, so you don’t have visible scars
- Transpalatal advancement pharyngoplasty: corrects a collapsed soft palate by removing part of your hard palate and opening your airway
- Uvulopalatopharyngoplasty (UPPP): removes or remodels tissue at the back of your throat, including your uvula, tonsils, adenoids, and hard palate
People with OSA related to obesity may be candidates for weight loss surgery. Weight loss surgery doesn’t directly address the structure of your airway, but it can make breathing easier by reducing excess fat in your tongue, neck, and throat. At Penn Medicine, bariatric surgeons and sleep apnea specialists work together to determine if weight loss surgery could partially or completely relieve your symptoms.
Who needs sleep apnea surgery?
OSA surgery is for people with severe symptoms that haven’t significantly improved with non-surgical treatments. We typically recommend lifestyle adjustments, CPAP therapy, or oral appliances before considering surgery. People who can’t wear a CPAP mask due to discomfort or claustrophobia may need to consider surgical treatment for sleep apnea. You must be healthy enough for surgery, so you may not be a candidate if you’re significantly overweight or have heart or lung conditions.
Surgery may be right for people with the following symptoms:
- Brief periods of not breathing while you sleep
- Daytime drowsiness and headaches
- Irritability or changes in mood
- Loud snoring followed by breathing interruptions
- Problems with memory and focus
- Waking up out of breath
What to expect from sleep apnea surgery
Sleep apnea surgery varies depending on what type of procedure you have. Some are outpatient procedures that allow you to go home the same day; more complicated surgeries may require a short hospital stay. Surgery typically takes anywhere from one to three hours.
Most surgeries require general anesthesia, so you’ll be asleep throughout the operation and won’t feel any pain. However, the risk of complications from general anesthesia is higher in people with sleep apnea. At Penn Medicine, surgeons and anesthesiologists work together to reduce your risk and closely monitor you during and after your procedure.
Your health-care provider will give you detailed instructions about how to prepare for sleep apnea surgery. You may need to:
- Try to quit using tobacco products at least a month before your procedure
- Stop taking certain medications, such as blood thinners, before surgery (always follow your doctor’s advice on taking or stopping medications)
- Avoid eating or drinking after midnight on the day of your surgery
- Bring your CPAP machine with you to the hospital if you need stay overnight
Sleep apnea surgery recovery
Recovery after sleep apnea surgery can last from one to six weeks. It may take several months to notice a significant improvement in your symptoms. Some people need to continue using their CPAP machine after surgery, but it should be easier.
Mild pain and bleeding after surgery are normal. Keep your head elevated when lying down to reduce swelling. Your provider may recommend a special diet of soft foods and liquids if you had mouth, throat, or jaw surgery. Avoid heavy lifting and strenuous activity for at least two weeks or until your provider tells you it’s safe to resume.
Sleep apnea surgery risks
Potential side effects of sleep apnea surgery include:
- Bleeding
- Changes to taste and smell
- Difficulty swallowing
- Infection
- Nerve injury
- Numbness in your mouth, nose, or throat
- Tongue paralysis
- Voice changes
Specialized expertise in advanced sleep apnea surgery at Penn Medicine
Penn Medicine’s team of experts in otorhinolaryngology, pulmonology, oral and maxillofacial surgery, and head and neck surgery work together to deliver seamlessly coordinated sleep apnea treatment tailored to your needs. Ours is one of only three sleep centers in the country designated by the National Institutes of Health as a specialized center for sleep research. This designation means that we stay at the forefront of the latest non-surgical and surgical treatments to help you find relief. In addition, surgical techniques that we invented here at Penn Medicine, such as TORS, are now used worldwide.
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