Sleep Apnea Surgery
Sleep apnea surgery may be an option for people who don’t tolerate CPAP or other more conservative treatments for sleep apnea. Doctors recommend different types of surgery depending on the severity of sleep apnea and where the airway blockage is. Surgery success rates and complications vary by procedure.
What Are the Types of Surgeries for Sleep Apnea?
Sleep apnea surgery is often a second line of treatment for sleep apnea, after CPAP. The different types of surgery for sleep apnea focus on removing blockages in a patient’s airway to help them breathe better during sleep. Surgeries may accomplish this by removing excess tissue, repositioning a person’s jaw or using implants.
Depending on the patient, this may involve nasal surgery, surgery for the jaw or surgery for the throat and tongue. Some patients may require more than one procedure. An ENT surgeon who specializes in the head and neck or an oral and maxillofacial surgeon who specializes in the mouth and jaw may perform sleep apnea surgery.
Several studies have shown that sleep apnea surgery may help improve sleep quality and reduce the number of apnea events in the right patients. Surgery is also an alternative to CPAP treatment for patients who can’t tolerate it or don’t receive enough benefits from it.
Uvulopalatopharyngoplasty (UPPP) is the most common surgery for obstructive sleep apnea (OSA). Surgeons remove excess tissue behind the tongue, shorten the soft palate and remove the uvula. Another form of UPPP called uvulopalatal flap (UPF) removes fat from the tonsils and soft palate.
The success rates in studies vary depending on the study, with a range between 16% and 83%, according to a 2021 study published in BJBMS. But recovery may take several weeks, and apnea symptoms may return, especially in obese patients.
Maxillomandibular Advancement (MMA) and Maxillomandibular Osteotomy (MMO)
Maxillomandibular advancement (MMA), also called maxillomandibular osteotomy (MMO), is a surgery where doctors break the upper and lower jaw and move them forward to make a person’s airway larger.
MMA is a more complex surgery, but available data shows it’s very effective for treating sleep apnea. It has an overall success rate of 86% and an overall cure rate of 43.2%. Patients with less severe sleep apnea had a cure rate of 66.7%.
Hypoglossal Nerve Stimulation
Hypoglossal nerve stimulation (HGNS) uses an implanted medical device created by Inspire Medical Systems. Surgeons place electrodes in the chest wall and a neurostimulator in a pocket under the clavicle. The electrode stimulates the hypoglossal nerve, causing the tongue to move forward to prevent it from blocking the airway.
One 2021 review of available medical literature published in the International Journal of Research and Public Health found HGNS was very effective for patients with moderate to severe obstructive sleep apnea. But study authors said more studies are needed to ensure the highest safety profile.
Radiofrequency Volumetric Tissue Reduction (RFVTR)
Radiofrequency volumetric tissue reduction (RFVTR) is a minimally invasive surgery that takes about 30 minutes to complete. Doctors use low-temperature, low-power radiofrequency energy to create lesions in the soft palate. In the next few weeks, the treated tissue reduces in size.
The evidence for the success rate of RFVTR is limited, but some studies have found this treatment reduces the severity of sleep apnea in the right patients. One study in Acta Oto-Laryngologica reported six participants were cured after treatment.
Soft Palate Implants
The Pillar procedure uses rod-like soft palate implants made of polyester to treat mild to moderate obstructive sleep apnea. It’s a minor surgery that takes about half an hour under local anesthesia.
The implant stiffens the soft palate and makes it less likely to block the airway or vibrate. In one study in Acta Oto-Laryngologica, sleep apnea severity, snoring intensity and daytime sleepiness dropped significantly.
Midline Glossectomy and Lingualplasty
Midline glossectomy, also called lingualplasty, is a surgery that reduces the size of the tongue. Sometimes this involves trimming the tonsils and back of the tongue. This enlarges the airway.
These surgical approaches are effective for treating mild to severe sleep apnea in adults and children, according to the American Academy of Otolaryngology-Head and Neck Surgery. It can be used alone or in combination with other surgical procedures such as UPPP.
Genioglossus advancement is a minimally invasive surgery where doctors detach the chin bone to pull the lower jaw forward. This makes it less likely for the tongue to clock the airway during sleep.
Recovery takes about a week and patients may start seeing results in about a month, according to Penn Medicine. Published studies show the success rate varies from 39% to 78%.
A hyoid suspension pulls the hyoid bone forward with sutures and secured to bone screws in the mandible. The hyoid bone is a U-shaped bone in the neck that attaches to the tongue and other tissues and muscles in the airway.
Moving the hyoid bone forward stabilizes the structures in the airway. It’s performed under general anesthesia and takes about an hour. It’s often combined with other techniques for better effectiveness.
Surgeons perform a tracheostomy to bypass the area of obstruction in people with sleep apnea. They create an opening in the trachea below the voice box. Patients plug the opening during the day so they can talk but remove the plug when they sleep.
This treatment is only used when all other treatments for severe sleep apnea have failed.
What Is the Success Rate of Sleep Apnea Surgery?
The success rate of sleep apnea surgery varies depending on the severity of sleep apnea and the health of the patient. Often, success rates are measured by how well a surgery reduces a patient’s Apnea-Hypopnea Index (AHI) score; a lower score means a person has fewer pauses in breathing in the span of an hour.
Success rates of various surgeries range from 33% to 100%, according to an article published in U.S. Pharmacist. The most effective surgery was tracheostomy because it can cure obstructive sleep apnea, according to study authors. But it has a number of drawbacks such as infections, recurrent bronchitis, speech difficulties and development of central sleep apnea.
Maxillomandibular advancement (MMA) is one of the most effective surgeries for sleep apnea and has one of the highest success rates at about 87%. Other studies say it’s between 75% and 100%. However, experts caution that it causes extreme changes in physical appearance because of the jaw repositioning. Before undergoing surgery, make sure you talk to your surgeon about which surgery will yield you the most benefits and fewest risks.
- Genioglossus advancement: 35% to 60%
- Hypoglossal nerve stimulation: 74%
- Maxillomandibular advancement: 87%
- Palatal Implants: 35%
- Tongue reduction: Glossectomy 60%, Transoral Robotic Surgery (TORS) 68%
- Tonsillectomy: Children 60% to 80%, Adults 65%
- Tracheostomy: 100% (Cure)
- UPF: 82%
- UPPP: 33%-50%
Risks and Side Effects of Surgery for Sleep Apnea
Sleep apnea surgery has the risks and side effects that come with any surgery, such as infections and reactions to anesthesia. In general, serious risks of surgery for sleep apnea are low, according to the University of California San Francisco.
Researchers are still studying treatments for sleep apnea. Some surgeries may have poorly understood risks.
- Allergic reactions to anesthesia
- Bad breath
- Blood clots
- Breathing problems
- Death (rare complication following UPPP)
- Excessive bleeding
- Persistent throat dryness
- Recurrence of obstructive sleep apnea or development of central sleep apnea
- Skeletal collapse
- Swelling around the surgery site
- Temporary numbness
- Tongue dysfunction or weakness
- Urinary retention
Complications differ on the type of surgery. Another thing to keep in mind is that people with sleep apnea are higher risk surgery patients because anesthesia relaxes throat muscles and increases the risk of airway collapse.
People with preexisting conditions may have a higher risk of complications. For example, obese people are more likely to have recurrence of obstructive sleep apnea after surgery.
Sleep Apnea Surgery Recovery Time
Depending on the extensiveness of the procedure, sleep apnea surgery recovery time varies from a few days to several weeks. For example, most people recover from hypoglossal nerve stimulation after a few days. But people who undergo an MMA procedure may have to stay in the hospital for a day or two, and it takes about two months to recover.
After the surgery, patients typically receive medications to prevent infection, pain and swelling. You should get plenty of rest and avoid heavy lifting. If you had tongue reduction surgery or UPPP, avoid mouthwashes because they may irritate the surgical site.
Some surgeries might not show benefits for a month or more. Talk to your doctor about a realistic recovery time and follow surgery aftercare instructions for optimal recovery. If you have excessive bleeding or signs of an infection, such as fever and redness or inflammation at the recovery site contact your doctor right away.
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