Choosing Surgery

Choosing Surgery to Treat Sleep Apnea

Your snoring and the feeling of being tired all the time led to a referral to a sleep center. Your evaluation there led to a sleep study that showed obstructive sleep apnea. You tried the conservative approaches like weight loss, sleeping on your sides instead of on your back, and avoiding alcohol in the late evenings. You also tried continuous positive airway pressure therapy (CPAP) but could not sleep comfortably through the night while wearing it. 

You are worried because you have been told that your sleep apnea can create health problems, in addition to the snoring and disruption of your sleep. You want to treat your sleep apnea but are not having success. What should you do next?

Surgery Is an Option

Sleep apnea surgery is an option for patients who do not have success with positive airway pressure therapy (such as CPAP). Surgery is designed to prevent the blockage of breathing that occurs in obstructive sleep apnea. Surgery can remove or reposition tissue to keep the space for breathing open during sleep. One key to achieving good results in sleep apnea surgery is determining the underlying cause of this blockage and breathing. At UCLA, our Department of Head and Neck Surgery includes international experts in sleep apnea surgery. They are leaders in the selection of surgical treatment based on examination in the office as well as drug-induced sleep endoscopy, a test performed in the operating room that is designed to determine the cause of obstructive sleep apnea. Based on these results, a sleep surgeon can discuss options that might be best for you.

The most common surgical treatments for obstructive sleep apnea can be grouped into the following categories:

Nose

A number of options exist to open the breathing passages in your nose. This can improve nasal breathing during the day and night. In some cases, it can make CPAP more comfortable and allow CPAP to work well.

The nasal septum separates one side of the nose from the other. The septum can be displaced to one side (deviated septum) to keep air from flowing freely through the nostrils. The nasal septum can be repositioned or reshaped in an outpatient procedure called a septoplasty. 

The turbinates are curved structures inside the nose that extend out from the sides of the nasal passages. Reducing the size of enlarged turbinates can open space for breathing. There are other causes of blockage in the nose, and these can also require surgery.

Palate

The soft palate is the back of the roof of the mouth, and this area includes the tonsils that are on the sides of the throat. Soft palate surgery is a common approach in sleep apnea surgery. Over the past 20 years, newer palate surgery techniques based on repositioning tissue have replaced the old-fashioned approaches of removing tissue for our team. These techniques have made soft palate surgery more effective while also decreasing potential risks. Palate surgery generally requires an overnight stay in the hospital following surgery.

Tongue

The tongue is a large muscle, and because muscles relax during sleep, the tongue can fall back in the throat to block breathing. 

One exciting approach is hypoglossal nerve stimulation. The hypoglossal nerve is the nerve that controls tongue movement, and stimulation of this nerve can move the tongue forward and treat obstructive sleep apnea. Hypoglossal nerve stimulation involves surgery to place a device in the upper chest and neck so that a patient can turn it on during sleep. The UCLA Head and Neck Surgery sleep surgery team includes the first surgeon in the Western US to offer this therapy after FDA approval in 2014, and our whole team has substantial experience and expertise that we use to discuss whether it is right for a patient before they undergo surgery. This is generally performed as outpatient surgery at UCLA.

We at UCLA perform a wide range of other procedures to treat obstructive sleep apnea focused on the tongue and structures near the tongue. These include tongue radiofrequency, genioglossus advancement, removal of the lingual tonsils (tonsils on the back of the tongue), and epiglottis surgery.

Jaw Advancement

 Maxillomandibular advancement or bimaxillary advancement is a surgery that involves moving forward the upper (maxilla) and lower (mandible) jaw. The jaws are held in a new position with metal plates and screws, and this procedure can open the entire throat.

Conclusion

It is crucial to talk openly with your sleep specialists, including your sleep surgeon. Make sure you understand why an approach may be right for you, weighing the risks and potential benefits. If you would like to discuss sleep apnea surgery options, please feel free to reach out to our experts in UCLA Head and Neck Surgery.