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Alaska Sleep Education Center

Surgery as a solution for sleep apnea

Posted by Julia Higginson on Apr 26, 2017, 2:00:21 PM

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Most people recognize nighttime snoring as a sign of sleep apnea. But did you know that long pauses in breathing, tossing and turning in bed, chronic mouth breathing while sleeping, daytime sleepiness, and night sweats due to an increased effort to breathe are also possible signs of apnea?

Listening to endless nights of snoring or witnessing pauses in breathing can lead to both frustration and worry. Receiving a diagnostic test in an AASM accredited lab, such as the Alaska Sleep Clinic, can be the first step towards easier breathing and restful sleep.

 

Sleep Apnea Treatments

The repeated stops and starts in breathing from sleep apnea increase the risk of heart disease, stroke, and diabetes.  Early intervention and the correct treatment plan can prevent some of these long-term medical complications as well as making it easier to sleep.

The first line of treatment is continuous positive airway pressure therapy (CPAP).  The use of a CPAP machine while you sleep increases the air pressure in your throat so your airway remains open as you breathe.  For some individuals, CPAP therapy proves to be difficult to deal with night after night.

A second option of surgery of the nose or throat can benefit individuals who struggle with or can’t tolerate CPAP therapy. There are three important things you should consider if you are thinking about surgery: not all surgeries are the same, the type of surgical procedure you will have depends on the cause of your sleep apnea, and not everyone is a good candidate for surgery.

Good candidates for surgery are those who are intolerant to CPAP therapy, healthy enough to tolerate surgery, and children who are likely to resist a CPAP machine.

Sleep Apnea Surgery

Surgery is a feasible alternative if you or your child are unable to sleep comfortably with a CPAP machine despite your best effort. Two reasons why many people have trouble sleeping with a CPAP are narrow nasal passages (often from a nasal obstruction or chronic congestion) or the need for high CPAP pressure.

The opening of the nasal passage can be opened with surgery if you are having trouble wearing CPAP equipment because of narrow nasal passages. There are a few options for surgery if you are having difficulty breathing against the high pressure of your CPAP. The two common causes of the need for high CPAP pressure are a blockage in the nasal passages or enlarged tonsils or adenoids. If this is the case with you, surgery in the nasal passage,

Two possible causes of high CPAP pressures that can respond to surgery are blockage in the nasal passages or enlarged tonsils or adenoids. In these cases, treatment of the nasal passages, the removal of the tonsils (tonsillectomy), or (adenoids) adenoidectomy can reduce CPAP pressures or even eliminate the need for CPAP therapy.

There are also other areas in the upper respiratory tract including the nose, tongue, and throat that can cause sleep apnea. Surgical options to treat these areas include:

  • Uvulopalatopharyngoplasty (UPPP): UPPP targets the back of the roof of your mouth. The surgery involves removal of the tonsils, repositioning of some of the muscles of the soft palate, and removal of excess tissue from the back of your throat to make your airway wider.
  • Radiofrequency volumetric tissue reduction (RFVTR): RFVTR ablation is an option if you have mild to moderate sleep apnea. The surgery shrinks and tightens the tissues in and around the throat to widen your airway.
  • Septoplasty and turbinate reduction: Septoplasty and turbinate reduction are used to open up your nasal passage to improve the flow of air. Septoplasty is meant for a bent or deviated nasal septum. Turbinate reduction is meant to reduce or remove the curved structures that stick out from the side of your nose.
  • Genioglossus advancement: As you sleep, your tongue can fall back into your mouth and make it difficult to breath. Geniodlossus advancement surgery moves the area where you tongue is attached forward so there is more space for breathing.
  • Hyoid suspension: Hyoid suspension surgery enlarges the space for breathing in the lower part of your throat.
  • Midline glossectomy and lingualplasty: These two surgeries involve removing part of the back of your tongue to prevent airway blockage.  
  • Maxillomandibular osteotomy (MMO) and advancement (MMA): This type of surgery is a treatment option for severe sleep apnea. MMO and MMA involves moving your upper and/or lower jaw forward to make more space for breathing.
  • Palatal implants: Palatal implants may be effective if you have mild sleep apnea. Small, fiber rods are inserted into the soft palate to stiffen the tissue and prevent airway blockage.

Surgery may be a multi-step process involving more than one procedure. You may also need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea. It is important to follow up regularly with your sleep physician after surgery. 

Apnea Surgery for Children

Apnea surgery can be a treatment option for patients ranging in age from newborn up into the 60s. One age group in particular that could benefit from surgery is children.

Sleep apnea can affect children of any age, but is most common in children between the ages of 2 and 6 years old. Young children often have a difficult time keeping a CPAP mask on as it can be bothersome or even scary as they sleep. The inability for children to use CPAP therapy makes them prime candidates for apnea surgery.

The most common sign your child might need sleep apnea surgery is loud snoring or noisy breathing while sleeping. Your child might also make gasping or snorting noises, breath through their mouth, or appear restless during sleep. A bad night’s sleep from breathing interruptions may result in your child being irritable, sleepy during the day, hyperactive, or having difficulty concentrating in school. Bed-wetting in potty-trained children can also be a sign of sleep apnea problems.

Untreated apnea in children can also lead to major health problems such as high blood pressure, poor growth, and heart problems. Sleep apnea can also cause behavior and learning issues. The specific surgery type your child needs is based on the cause of their apnea.

The most common type of surgery for children is the removal of the tonsils or adenoids or to correct any abnormalities of the face or airway. This is because swollen tonsils and adenoids are often the cause of their sleep apnea. If your child has enlarged tonsils or adenoids, the airway becomes blocked making it harder to breath. Other types of surgery are occasionally needed if your child has craniofacial abnormalities.

Most of the time, children will recover within six months of surgery with no more signs of sleep apnea. With the help of the Alaska Sleep Clinic, we can help you make the decision if surgery is right for your child. The decision for surgery is determined based on: 

  • Your child’s age, overall health, and medical history
  • Cause of the condition
  • Your child’s tolerance for specific medications, procedures, or therapies

 

Want to learn more?

Making the decision to have surgery for your sleep apnea can be a difficult choice to make. You should seek out and commit to a treatment that will work best for you. Choosing the right path for your apnea treatment should be part of a careful discussion between you, your sleep physician and other specialists, such as surgeons, sleep-certified dentists, and otolaryngologists. Ultimately, when making the decision to have surgery you should consider the risks versus the benefits, it the surgery will be effective, and if you are healthy enough for surgery.

You may find yourself with many unanswered questions and still wondering if surgery is right for you. Check out the video below where Dr. Eric Nordstrom of the Alaska Center for Oral and Facial Surgery discusses how oral surgery can be a solution for sleep apnea.

Do you want to know more about whether apnea surgery is the right the solution for you or your child? Consult with one of our sleep specialists today so you can get back to healthy sleeping.

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