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What surgeries are available to cure sleep apnea?

Uvulopalatopharyngoplasty (UPPP) involves the removal of part of the soft palate, uvula and redundant peripharyngeal tissues, sometimes including the tonsils. This surgery removes tissue from the rear of the mouth and top of the throat. The tissues removed include parts of the uvula (the flap of tissue that hangs down at the back of the mouth), the soft palate, and the pharynx. Tonsils and adenoids are usually removed in this operation. This operation significantly improves sleep apnea in slightly more than half of all cases. Uvulopalatopharyngoplasty is recommended only for select patients

with severe obstructive sleep apnea.

Laser-assisted uvulopalatoplasty (LAUP) can be performed in a series of office treatments and thus has become more popular than UPPP in recent years. The clinical indications for this procedure, as well as its effectiveness, have not yet been clearly defined. Some sleep experts recommend the use of LAUP in patients who have snoring and mild apnea or patients who have no significant apnea but want to alleviate snoring.

Tracheostomy used to be the only treatment for sleep apnea. It is quite straightforward. The surgeon makes an opening through the neck into the windpipe and inserts a tube. It is almost 100% successful, but it requires a quarter-size opening in the throat. In this procedure, an opening is made into the trachea (windpipe) below the obstruction, and a tube inserted to maintain an air passage. A tracheostomy requires a great deal of care to prevent infection of the tracheostomy site. In addition, since air is no longer being filtered and moistened by the nasal passages before entering the lungs, the lower airways can become dry and susceptible to infection as well. Tracheostomy is usually reserved for those whose apnea has led to life-threatening heart arrhythmias, and who have not been treated successfully with other treatments.

A technique called radiofrequency ablation is of interest. It uses radio waves emitted from an electrode to treat patients who snore. The radio waves destroy a small amount of tissue at the base of the tongue. The therapy takes about twenty minutes. It typically requires 10 treatments within five or six sessions. (A newer form requires fewer treatment sessions because it provides more concentrated radio waves, and it appears to be effective.) The procedure causes some discomfort, which can be controlled with simple pain relievers. It is far less invasive than standard surgery, and studies are reporting significant improvement in reduced snoring and less daytime sleepiness. It may be helpful for mild obstructive sleep apnea.

Jaw surgery is the most invasive surgical procedure used to treat obstructive sleep apnea. Patients who have a small, retrognathic mandible and have failed more conservative treatments may be candidates for this approach. The surgical procedure may be limited to pulling the tongue forward (genioplasty). An extensive procedure may entail moving both the mandible and maxilla. Extensive jaw surgery has a higher complication rate and a longer recovery time.

Gastric surgery might be a consideration in some morbidly obese patients with obstructive sleep apnea. How weight loss causes a lessening of apnea is not clear, but it is presumably through a reduction in the adipose level of parapharyngeal tissues.

More information on sleep apnea

What is sleep apnea? - Sleep apnea is a disorder in which a person stops breathing during the night. Sleep apnea means cessation of breath characterized by repetitive episodes of upper airway obstruction.
What types of sleep apnea are there? - There are three types of sleep apnea, including obstructive sleep apnea (OSA), central sleep apnea, mixed sleep apnea.
What is obstructive sleep apnea? - Obstructive sleep apnea is a disorder in which complete or partial obstruction of the airway during sleep causes loud snoring, oxyhemoglobin desaturations and frequent arousals.
What causes obstructive sleep apnea? - Obstructive sleep apnea is caused by repetitive upper airway obstruction during sleep as a result of narrowing of the respiratory passages.
What're the symptoms of obstructive sleep apnea? - Symptoms of obstructive sleep apnea include loud snoring, Daytime sleepiness, memory changes, depression, and irritability.
What is central sleep apnea? - Central sleep apnea is a sleep breathing disorder that occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations.
What causes central sleep apnea? - Conditions that can cause sentral sleep apnea include bulbar poliomyelitis, encephalitis affecting the brainstem, neurodegenerative illnesses.
What're the symptoms of central sleep apnea? - Symptoms of central sleep apnea include extreme exhaustion and sleepiness during daylight hours, early morning headaches, lack of concentration, and memory loss.
What are the risk factors for sleep apnea? - There are several factors that may predispose a person towards sleep apnea, including gender, age, ethnicity, geography, obesity, immune abnormalities.
What are the complications of sleep apnea? - Sleep apnea is a potentially life-threatening condition because there are interruptions in breathing during sleep.
How is sleep apnea diagnosed? - A sleep test, called polysomnography is done to diagnose sleep apnea. Confirmation of the diagnosis requires making measurements while the person sleeps.
What's the treatment to stop sleep apnea? - Treatment for sleep apnea is determined based on the individual's specific circumstances and can include behavioral changes, physical therapy and surgery.
What surgeries are available to cure sleep apnea? - Surgeries to stop sleep apnea include uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, tracheostomy, radiofrequency ablation.
What about the CPAP therapy for sleep apnea? - The most effective treatment for sleep apnea is nasal continuous positive airflow pressure (CPAP) therapy.
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