The Basics

The vast majority of patients with sleep apnea have the obstructive variety called Obstructive Sleep Apnea (OSA). There are a variety of treatments available for OSA.

A few patients may try oral or dental appliances. These devices have the same success rate as surgical intervention. They work best in patients with only mild to moderate OSA.

A nasal air pressure mask called CPAP (continuous positive airway pressure) is the standard treatment for Obstructive Sleep Apnea, with a success rate of 95-98%. Approximately 2-5% of patients who try this therapy experience claustrophobia or do not wish to use CPAP long term. For these individuals, as well as patients who snore but do not have OSA, an oral appliance or surgery may be options. In selected cases, it may be suggested that a patient who is considering treatment with a CPAP mask be evaluated by an ENT (ear, nose, and throat) physician to assure that his or her nose anatomy is adequate. Surgical correction of nasal obstruction may enhance the use of CPAP or improve OSA.

Surgical Options

There are several types of surgery for snoring and sleep apnea, with varying success rates.

The most common types include Tonsillectomy and Adenoidectomy (which are the removal of the tonsils and adenoids).

An excess of soft tissue or enlarged tonsil at the back of the throat may contribute significantly to obstruction of the airway.

Uvulopalatopharyngoplasty (or UPPP for short). The tonsils and adenoids are removed, in addition to carving out some of the hard and soft palate (the back and top of the mouth), removing the uvula (the "little tongue" that hangs down the back of the throat), and removing any other tissues or organs which may be enlarged, blocking the airway. This procedure can also be performed with laser assistance (as opposed the traditional scalpel method). This is called a LAUP. While the UPPP is done in one visit, the LAUP is performed over several visits, usually 3-6 times.

Nasal Septoplasty is used to correct blockages in the nasal passages caused by deformed cartilage from old injuries, polyps, or inflamed tissues. Some patients may have a deviated septum (the cartilage that separates the two nostrils blocks airflow to one side of the nose) which needs correction.

The most intrusive type of surgery is called Mandibular Osteotomy with Geniohyoid and Bimaxillary Advancement. In this case, the lower jaw is broken and advanced, enlarging the airway. Muscles in the chin may be permanently pulled forward to further enlarge the airway. If necessary, surgery may be performed to reduce the size of the base of the tongue.

The most recent advance in surgical techniques is called Somnoplasty. This method uses microwaves (bursts of radio frequencies) to reduce obstruction at the base of the tongue. Somnoplasty may need to be repeated to guarantee results.

Tracheostomy. This is surgical procedure creates a permanent hole in the neck to bypass the obstruction in the upper airway. This is generally performed as a last resort for patients with severe OSA, not responsive to other treatments.