Surgical procedures for sleep apnea
Surgeries for OSA focus on different parts of the upper airway — generally the nose, mouth and throat. Here are some of the options.
Nasal and sinus procedures
For some people, blockages in the nose and sinuses may contribute to OSA. Procedures to help address these obstructions include3:
- Septoplasty to correct a deviated septum (when the wall between your nostrils is off-centre, which can make breathing difficult).
- Turbinate reduction to shrink swollen tissue inside your nose, which improves nasal airflow and helps you breathe easier.
- Nasal valve surgery to strengthen the narrowest part of your nasal airway, preventing it from collapsing when you breathe in through your nose.
- Sinus procedures to treat and reduce symptoms of chronic sinusitis (inflammation in the sinuses that makes it hard to breathe through your nose).
These procedures may be performed in combination with other surgeries to make CPAP more comfortable and easier to use. In fact, in one study, nearly every participant’s experience with CPAP improved after having nasal and sinus procedures.3
Palate and pharyngeal procedures
Other OSA surgeries focus on the roof of the mouth (palate) or the part of the throat behind the mouth and nose (pharynx). Most of these procedures aim to improve and open the airway, making it easier to breathe.
Uvulopalatopharyngoplasty (UPPP)
Uvulopalatopharyngoplasty (UPPP) is the most common sleep surgical procedure in the world.2 It can involve reshaping the muscles in the palate or removing excess tissue from the soft palate, pharynx or uvula.
In the modern approach to UPPP, surgeons tailor treatment to each person’s needs to improve results and reduce complications.2 For example, if the sides of your throat tend to collapse, a lateral pharyngoplasty can be done to reshape those muscles. Alternatively, an expansion sphincter pharyngoplasty could be used to rotate a muscle to address the collapse.27
Palate implants and minimally invasive options
Implants, small devices, and other minimally invasive procedures are also options. These can include:
- A pillar procedure, which uses implants to stiffen the soft palate.
- Radiofrequency ablation of the soft palate to reduce tissue volume.
- Laser-assisted uvulopalatoplasty (LAUP) for mild cases.
One study explored the effectiveness of the pillar procedure for people with sleep apnea. In the study:4
- 36.7% of people experienced fewer nights of snoring.
- 73.3% reported a reduction in how loud they snored.
- 33.3% noted less daytime sleepiness.
Because no tissue is removed during this procedure, recovery is relatively quick, and individuals may experience less pain than other methods.
Radiofrequency ablation uses radio waves to shrink tissues in the airway, alleviating blockages. It can be done in a doctor’s office with local anaesthesia and may be minimally painful. Studies have found this procedure to be effective, with some research suggesting that 51% of people had a complete response at a 6-month follow-up,5 meaning their symptoms improved or went away completely.
During a laser-assisted uvulopalatoplasty (LAUP) procedure, a laser is used to shorten the uvula and remove excess tissue from the soft palate. Though recovery from this procedure can be quick, some research has found that it is minimally effective. One study found LAUP to only yield a cure rate of 8%.6
Tongue-based procedures
Another area of focus for obstructive sleep apnea (OSA) surgeries is the tongue. If the tongue is too large or positioned in a particular way, it can block the airway when someone is lying down. These procedures aim to correct that.
Tongue reduction techniques
Multiple options are available for reducing the size of the tongue, including28:
- Radiofrequency ablation, which uses radio waves to shrink the tissue at the base of the tongue.
- Transoral robotic surgery (TORS), which uses a robot arm to assist in accessing and treating hard-to-reach tissues in the back of the throat.
- Midline glossectomy, which reduces the volume of the tongue by removing tissue using a special tool called a plasma wand.
Tongue advancement and stabilisation
Rather than reducing the size of the tongue, the following procedures focus on positioning it to prevent blockages.
- Genioglossus advancement to reposition the tongue base, where the muscle attached to the lower jaw is pulled forward to reduce the likelihood of tongue collapse during sleep.29
- Hyoid suspension, which uses two small screws inserted into the jaw and a suture inserted into the hyoid bone (a small U-shaped bone in the front of the neck, between the chin and the Adam’s apple) to stabilise the airway and pull the jaw forward.7
- Tongue suspension procedures using sutures or implants to prevent the tongue from falling backward and blocking the airway during sleep.30
- Combination approaches for blockages in multiple areas of the airway.
Skeletal procedures
Skeletal procedures focus on the jaw and other bones in the face to treat obstructive sleep apnea (OSA).
Maxillomandibular advancement (MMA)
Maxillomandibular advancement (MMA) involves moving the upper and lower jaws forward about 10 mm. On the plus side, MMA delivers high success rates. In fact, one study suggests it may reduce nighttime breathing issues by up to 83%.8 On the other hand, it comes with orthodontic considerations, significant facial changes and an extended recovery.
Other skeletal interventions
Other skeletal interventions include:
- Distraction osteogenesis techniques. In this procedure, a surgeon separates a bone to create space. The body then naturally fills the space with new bone as it heals. For people with OSA, this procedure can help reshape the airway and reduce breathing interruptions during sleep.
- Counterclockwise rotation of the maxillomandibular complex. Similar to the MMA procedure, this procedure moves both the upper and lower jaws forward and slightly rotates them. The adjustments help open the airway, allowing for better breathing during sleep.31
People with unique craniofacial abnormalities, such as a small jawbone or enlarged tongue, may need an individualised, carefully planned approach with a team of doctors to manage OSA with skeletal procedures.
Hypoglossal nerve stimulation
Hypoglossal nerve stimulation is a procedure in which a small device is implanted into the neck or chest. The device sends signals to the hypoglossal nerve, a motor nerve that controls the tongue. Doing so helps move the tongue forward during sleep, so it doesn’t block the airway.
Candidates for this procedure must be at least 18 years old and have moderate to severe sleep apnea. They must have tried continuous positive airway pressure (CPAP) therapy and determined that it was not a good treatment for them.
Candidates also must not have complete collapse of the soft palate, which is when the soft palate and sides of throat collapse inwards.9 This procedure is reversible and adjustable, so it can be tailored to an individual’s needs over time.
Research has found hypoglossal nerve stimulation to be an effective option for treating obstructive sleep apnea (OSA), significantly reducing breathing pauses in both the short- and long-term.10
Tracheostomy
A tracheostomy is a procedure that bypasses the upper airway. A surgeon creates a permanent opening into the trachea and inserts a tube into the opening. This tube enables people to breathe at night through the trachea, completely bypassing the upper airway.
A tracheostomy is generally only used for severe or life-threatening cases of sleep apnea, or for people who have not had success with any other treatment options.11 While a tracheostomy can cure OSA, it can have significant life impacts, including complications like tube displacement, weakening of the tracheal wall and infection.12
