Reduce or eliminate obstructive sleep apneaImprove the ability to tolerate positive airway pressure (PAP) therapy or alternatives like an oral appliance mouthpiece

For those who are interested in obstructive sleep apnea surgery, it is important to understand the factors that relate to the diagnosis and procedure selection.

Obstructive sleep apnea is a disorder in which a person has a blockage of breathing during sleep. It can lead to loud snoring, disruption of sleep, and health consequences.

Treatments include conservative approaches (such as weight loss, avoidance of alcohol before bedtime, and avoiding sleeping on one’s back), positive airway pressure therapy (for example, CPAP), surgery, and oral appliance mouthpieces. 

Obstructive sleep apnea surgery is usually performed in people who are unable to tolerate or benefit from conservative treatments or positive airway pressure therapy. Surgery can be designed to eliminate the sleep apnea entirely, but surgery can also be designed to enhance comfort with ongoing positive airway pressure therapy.

There are many potential sleep apnea surgeries, and no procedure is best for everyone. Research studies have shown that different people have different causes of their sleep apnea, and these different causes suggest different procedures. It is important to target the surgical treatment to an individual’s needs.

To treat obstructive sleep apnea with surgery alone, generally, this involves surgery of the throat. Some available procedures include: 

Uvulopalatopharyngoplasty Newer soft palate surgery techniques Tongue radiofrequency Genioglossus advancement Hyoid suspension Inspire Upper Airway Stimulation® Jaw advancement (maxillomandibular advancement or bimaxillary advancement)

Nasal procedures such as septoplasty or inferior turbinate reduction can treat nasal obstruction, which can be very important for people with obstructive sleep apnea.

Nasal obstruction can also lead to mouth breathing. While mouth breathing can actually narrow the space for breathing in the throat, for people who have severe nasal obstruction, mouth breathing can be the only way that a person can breathe at all. 

There are many reasons that people may find positive airway pressure therapy uncomfortable, and one reason is nasal obstruction. Because positive airway pressure therapy often involves delivery of pressurized air through the nose, narrow nasal passages can make it harder for air to flow in and out of the nose during sleep.

If a person has nasal obstruction that does not respond to medications, such as a trial of fluticasone or intermittent use of Afrin, surgery may be an option.

Similarly, nasal obstruction can also make wearing an oral appliance mouthpiece uncomfortable. If the nasal obstruction does not improve with medications, surgery may be an option to enhance tolerance of wearing the oral appliance.

Criteria

Depending on the nature of the surgery, there may be certain criteria that must be met prior to surgery in order to have the procedure performed. The results of testing are described below, but in some cases, it may be important to fail medical management for insurance to approve a surgical procedure.

As an example, failure of the treatment of allergies with a nasal steroid spray for one month may be needed prior to qualifying for surgery to remove the turbinates within the nose.

These criteria may vary and should be determined by the surgeon during the pre-operative evaluation.

Tests and Labs

All people considering sleep apnea surgery should have a sleep study confirming the diagnosis of obstructive sleep apnea. This may be done as a home sleep apnea test (HSAT) or an in-center diagnostic polysomnogram.

If in the mild range (from 5 to 15 events per hour), to qualify for treatment some insurance will require associated symptoms to be present, such as excessive daytime sleepiness, insomnia, hypertension, or depression. If moderate to severe (more than 15 events per hour), these comorbid conditions need not be present.

A person should have also undergone a trial of positive airway pressure therapy in order to learn whether they can sleep comfortably while wearing it regularly. If this fails, it may be an indication to proceed with surgery.

Preparing for surgery often involves preoperative routine blood tests and an electrocardiogram (EKG). Other testing may be necessary for a person to be medically safe (cleared) for surgery.

A Word From Verywell

Obstructive sleep apnea surgery is surgery. Before considering sleep apnea surgery, a person should have a clear sense of the purpose and be medically stable to maximize surgery safety. Surgery can be a helpful intervention and often benefits from careful consideration prior to the procedure.

If interested in your treatment options, seek an assessment by a board-certified sleep physician and undergo a surgical evaluation by an otolaryngologist-head and neck surgeon, also know as an ear, nose, and throat (ENT) specialist.