Sleep Apnea Surgery

Obstructive sleep apnea happens when the soft walls of the throat relax during sleep and the airway narrows or closes, often at more than one level. Surgery aims to enlarge the airway or keep it open. Nasal surgery, such as straightening the septum or reducing the turbinates, improves airflow through the nose and often makes CPAP more comfortable, although on its own it rarely cures sleep apnea. Palate surgery, including uvulopalatopharyngoplasty, or UPPP, and its modern variations, removes or repositions tissue of the soft palate, uvula and tonsils to widen the back of the throat. Tongue-base procedures reduce or reposition tissue at the back of the tongue. Hypoglossal nerve stimulation uses a small implanted device that gently stimulates the nerve that moves the tongue with each breath, keeping it forward during sleep. Maxillomandibular advancement moves the upper and lower jaws forward, enlarging the whole airway.

Surgery is considered for adults with confirmed obstructive sleep apnea who have tried CPAP properly and cannot use it, for example because of mask discomfort, claustrophobia or air leaks, and for whom an oral appliance has failed or is unsuitable. It can also be offered when a clear anatomical cause is found, such as very large tonsils, a severely blocked nose or a small, set-back jaw. In children, removing enlarged tonsils and adenoids is usually the first treatment for sleep apnea. Hypoglossal nerve stimulation is generally offered to people with moderate to severe sleep apnea who cannot use CPAP, who are not severely overweight and whose airway does not collapse in a complete ring on sleep endoscopy. Jaw advancement is considered for moderate to severe sleep apnea, especially when the jaws are small. Weight loss, sleeping position and treatment of nasal blockage are part of the plan in every case.

Most procedures are done under general anaesthesia. Before deciding, many teams perform drug-induced sleep endoscopy: under light sedation that mimics sleep, a thin camera passed through the nose shows where the airway collapses. In palate surgery, the tonsils are usually removed and the soft palate and side walls of the throat are trimmed or stitched into a wider shape, working through the mouth. Tongue-base procedures may shrink tissue with radiofrequency energy, remove tonsil tissue at the back of the tongue or reposition the tongue muscle attachments. For hypoglossal nerve stimulation, a small generator is placed under the skin below the collarbone and a cuff is fitted around a branch of the nerve under the jaw, sometimes with a breathing sensor between the ribs, and the device is switched on about a month later. In jaw advancement, cuts are made in both jaws through the mouth, and the jaws are moved forward and fixed with plates and screws.

Assessment starts with a recent sleep study confirming the diagnosis and severity, and a record of what has been tried, including CPAP usage data from the machine where available. An ear, nose and throat surgeon examines the nose, mouth and throat, often with a flexible camera, and many patients have drug-induced sleep endoscopy; jaw surgery planning adds a CT scan and dental records. Body weight matters: surgery generally works less well with severe obesity, and weight loss, sometimes including bariatric surgery, may come first. Your general health, heart and lung function and medicines are reviewed, and blood thinners may need adjusting. Stopping smoking helps healing. Bring your sleep study reports, CPAP data and any previous imaging. For international patients, these can usually be reviewed remotely so that a likely surgical plan is suggested before travel, with the sleep endoscopy done on arrival before the final decision.

Recovery depends on the procedure. After nasal surgery, most people go home the same day or the next day, with a blocked nose for one to two weeks. Palate and tongue-base surgery is more uncomfortable: a sore throat, painful swallowing and ear pain are common for about 10 to 14 days, managed with a soft diet, regular pain relief and plenty of fluids. Bleeding from the throat can occur up to about two weeks later, which is why staying near the hospital matters. After a hypoglossal nerve stimulator implant, discomfort is usually mild and most people resume normal activity within one to two weeks, but the device is switched on and adjusted at later visits. Jaw advancement needs a few nights in hospital, a liquid and then soft diet for several weeks, and swelling settles over weeks. Plan about 7 to 14 days abroad for most procedures, longer for jaw surgery, and arrange a follow-up sleep study near home.

Every airway operation carries the general risks of anaesthesia, bleeding and infection. After palate surgery, possible problems include bleeding in the first two weeks, temporary or occasionally lasting changes to the voice, difficulty swallowing, a feeling of something in the throat and, rarely, fluid passing into the nose when drinking. Tongue-base surgery can cause swelling, taste changes or temporary swallowing difficulty. Hypoglossal nerve stimulation can cause tongue discomfort, infection or the need to reposition or remove the device. Jaw advancement may leave numbness of the lower lip and chin, a change in the bite and a change in facial appearance. Results are measured with a repeat sleep study after healing, usually about three months later. Many people sleep and breathe better, but surgery does not always remove sleep apnea completely, and some people still need CPAP, often at a lower pressure, or an oral appliance afterwards.