Sleep Apnea

Surgery

Surgery for obstructive sleep apnea (OSA) is usually not done unless other treatments have failed or you are unable or choose not to use other treatments.

Surgery Choices

• Uvulopalatopharyngoplasty removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
• Tonsillectomy and/or adenoidectomy removes the tonsils and/or the adenoids. It is an option if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
• Other surgical procedures are used to repair bone and tissue problems in the mouth and throat.
• Tracheostomy creates a hole in the windpipe (trachea). A tube is then put in the hole to bring air in. Doctors rarely use this surgery because it may cause other health problems. But when other techniques have failed, almost all people who are treated with tracheostomy will be cured of their sleep apnea.
• Bariatric surgery is done for weight loss. If you are extremely overweight (severely obese) and the excess weight is making your sleep apnea worse, you may consider surgery to help you lose weight. Bariatric surgery can promote weight loss that improves sleep apnea.⁸

Should I have surgery to treat obstructive sleep apnea?

Surgery for children

Tonsillectomy and/or adenoidectomy generally is the first choice for children, because enlarged tonsils or adenoids cause most cases of sleep apnea in children. Other types of surgery may be needed to correct birth defects that can cause sleep apnea symptoms.

What To Think About

If you are thinking about having surgery to treat sleep apnea, talk with your doctor about having a sleep study done first. Experts generally suggest trying continuous positive airway pressure (CPAP) before considering surgery. CPAP is a machine that increases air pressure in the throat and prevents tissues in the airway from collapsing when you breathe in.

In adults, uvulopalatopharyngoplasty (UPPP) is the most common surgery used to treat sleep apnea.

• There is no clear research on how well UPPP works for sleep apnea.¹⁵
• UPPP may stop snoring, but apnea episodes may continue.¹
• Limited research indicates that about 40% to 60% of people who have UPPP see an improvement in their symptoms.²
• You may still need other forms of treatment, including continuous positive airway pressure (CPAP), after surgery.
• You will need sleep studies after surgery to make sure periods of apnea do not continue or return.
• UPPP usually is not used to treat sleep apnea in children.

Tracheostomy is used only when all other treatments for severe sleep apnea have failed or when you cannot tolerate other treatments.

A rarely used option is repositioning facial bones (maxillofacial reconstruction) if CPAP or UPPP do not work. This surgery is designed to increase the size of the bones around the tongue and to create pull (traction) on the base of the tongue, which enlarges the airway. You will usually need more than one surgery.

Laser-assisted uvulopalatoplasty uses a laser to perform surgery. It is sometimes used to treat mild to moderate sleep apnea, although not all people benefit. This surgery is not approved by the American Academy of Sleep Medicine to treat sleep apnea.¹²

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Author:	Maria G. Essig, MS, ELS	Last Updated: July 13, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Jan Ulfberg, MD, PhD - Sleep Disorders
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