SURGERY FOR OBSTRUCTIVE SLEEP APNEA
Am I a Candidate?
In order to be a candidate, positive airway pressure (PAP) should be tried as a first-line treatment for OSA. This is also commonly known as CPAP. If you are not able to consistently use PAP or CPAP therapy, there are other treatment options, including oral appliance and surgery.
What are the Surgical Options?
There are numerous types of throat surgery for OSA. It is critical to choose the procedure that corrects the individual’s source(s) of obstruction.
Studies have shown that determining the location of the obstruction site can significantly increase success rates. There are two main sources of obstruction:
- The soft palate and the tongue (shown below). In each patient, the surgeon will attempt to identify whether there exists a single site of obstruction or a multilevel obstruction. This identification is done with a fiber-optic endoscope examination performed through one of the nostrils. The exam can be done in the clinic with the patient awake or with the patient under sedation in the endoscopy suite or operating room. The sedated exam is called drug-induced sleep endoscopy (DISE) and is intended to recreate natural sleep.
- Diagram below with the X marks obstruction behind the soft palate, O marks obstruction behind the tongue base.
There are four different classes of surgery to improve blockage in the throat:
Each of these surgery classes can address both soft palate and tongue-based obstruction. Choosing among the four options requires consideration of each patient’s OSA severity, throat anatomy, body weight, medical problems and personal preference.
Note: More than one procedure may be needed to satisfactorily address OSA. If so, the above surgery classes may be performed in a staged manner.
Soft tissue surgery
Soft tissue surgeries involve direct manipulation of the soft palate and tongue musculature. The most common type of soft tissue surgery for OSA is uvulopalatopharyngoplasty (UPPP). A modified version of UPPP, known as expansion sphincter pharyngoplasty, has become increasingly popular (this procedure is particularly effective in patients with lateral pharyngeal wall obstruction). If more than one anatomical site is obstructed, the surgeon might recommend multilevel surgery for the OSA patient (e.g. nose, palate and/or tongue surgery).
Below is a list of available soft tissue surgeries:
- Submucous Resection
- Turbinate Reduction
- Turbinate Radiofrequency
- Endoscopic Sinus Surgery
- Palatine Tonsillectomy
- Anterior Palatoplasty
- Expansion Sphincter Pharyngoplasty
- Uvulo-Palatal Flap
- UvuloPalatoPharyngoPlasty (UPPP)
- Lingual Tonsillectomy
- Midline Glossectomy
- Tongue Suspension
There exist several skeletal surgeries, each designed to address single obstruction (palate or tongue) or double-obstruction. Most commonly, maxillomandibular advancement (MMA), also known as double-jaw surgery is performed to treat double-obstruction. MMA has been shown to be effective in treating OSA. Given the significant recovery time, however, MMA is reserved for motivated patients with limited health problems.
Other skeletal surgeries:
- TransPalatal Advancement Pharyngoplasty
Tongue or Hyoid Bone
- Genioglossus Advancement Mandibulotomy
- Hyoid suspension
Nerve stimulation therapy represents the most recent advancement in sleep surgery. This therapy works by delivering electrical stimulation to the nerve which controls tongue movement (hypoglossal nerve). In essence, electrical stimulation of the tongue prevents falling back of the tongue and soft palate into the airway. Thus, this treatment is designed to treat double-obstruction.
Inspire therapy is a breakthrough implantable treatment option for people with Obstructive Sleep Apnea who are unable to use or get consistent benefit from Continuous Positive Airway Pressure (CPAP). While you’re sleeping, Inspire monitors every breath you take. Based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.
The Inspire obstructive sleep apnea device is controlled by a small handheld sleep remote. The remote allows you to turn Inspire therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.
While you’re sleeping, breathing patterns are constantly monitored and the result is not only a consistent flow of oxygen to the brain, but you’ll also awake refreshed and rested. Controlled by a handheld remote, one simply turns it on when going to bed and then off in the morning.
Inspire therapy is a great solution for patients who are resistant to Continuous Positive Airway Pressure (CPAP). So, if you’re ready to ditch the CPAP machine forever, contact our offices at 310.247.9090 to obtain more details.
HOW INSPIRE THERAPY WORKS
ImThera® is another nerve stimulator, but does not include a respiratory sensing lead. It is commercially available in several European countries as well as Colombia.
Upper airway bypass surgery
Tracheostomy can be performed as a means of bypassing the upper airway. Tracheostomy is generally highly effective in treating OSA. The main drawbacks of the surgery are aesthetic concerns, maintenance of the stoma (neck opening) and lifestyle change (not able to participate in activities involving submersion in water such as swimming).
Please call us at 310.247.9090 to discuss your treatment options and to schedule a consultation.