Surgery to Treat Obstructive Sleep Apnea

About 30 million people in the United States have sleep apnea, making it a common sleep disorder. If a person has obstructive sleep apnea (OSA), they have shallow breathing or stop breathing for 10 seconds or longer while asleep. They also tend to snore loudly or may snort, gasp, or choke during sleep. Not all people with sleep apnea snore.^1-4

The good news is that sleep apnea can be treated. OSA is most often treated with a combination of lifestyle changes and machines to help with breathing. However, sometimes surgery may be recommended. Your sleep doctor will need to work with an otolaryngologist (ENT), an oral surgeon, or a bariatric surgeon to decide if surgery is right for you.^5-7

Surgery for obstructive sleep apnea

Surgery may be recommended if a person has a lesion, tonsils, adenoids, or a birth defect that partly blocks the airway. Surgery is generally only done on people with moderate to severe OSA if a CPAP machine does not provide enough relief. There is no set standard for who should have surgery for sleep apnea. In extreme cases, a tracheostomy (hole in the neck) can be considered, but this is rarely performed for sleep apnea.⁷

Surgery to remove extra tissue

Some people with moderate to severe sleep apnea may need surgery to reduce, eliminate, or reposition tissue in and around the throat. The goal is to treat the areas that collapse and block the airway during sleep, such as:^5-7

• Soft palate and uvula
• Tonsils and adenoids
• Tongue

Most people try a positive airway pressure machine (CPAP, BPAP, or APAP) or mouth appliance for at least 3 months before surgery is considered.⁷

Surgery to change bone structure

Less often, a person may need complex facial surgery to adjust bones in the jaw, nose, or other parts of the face.⁵

Studies show that surgery that removes extra tissue or changes facial bone structure often improves, but may not eliminate sleep apnea. Also, not everyone is well enough to withstand surgery.⁷

Weight loss surgery for sleep apnea

Weight loss surgery may be an option for people with obesity and moderate to severe sleep apnea.^5-7

Hypoglossal nerve stimulation

There is a nerve stimulation device that may work for certain people with moderate to severe OSA. It is called a hypoglossal nerve stimulation device and is sold under the brand name Inspire. The device has a remote control, so it can be turned on before going to sleep and turned off in the morning.

Inspire is placed under the skin of the neck and chest through 2 small incisions. Inspire synchs with your breathing at night and stimulates a motor nerve to nudge your tongue forward while you sleep. This keeps your airway open so you can breathe normally and peacefully. To qualify for Inspire, you must:^5,7

• Have struggled with CPAP or been unable to get consistent benefits from it
• Be 18 years or older
• Have a body mass index (BMI) below 32 (this varies by payor and can go up to 40)
• Be diagnosed with moderate to severe obstructive sleep apnea with an apnea-hypopnea index (AHI) between 15 and 100
• Children with Down syndrome 13 or older with severe OSA (AHI 10-50) who have already had their tonsils and adenoids removed

Before any surgery for sleep apnea is considered, your doctor will want to conduct a complete review of your medical history and current overall health. Surgery is usually a treatment of last resort, so lifestyle changes and CPAP machines will be tried first.