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Sleep Apnea; Surgical Treatments for Obstructive Sleep Apnea

The surgical OSA treatments.

There are several surgical options available for the relief of snoring and obstructive sleep apnea.

The UPPP (Uvulopalatopharyngoplasty)

The oldest and most frequently performed type of snoring related surgery is called a UPPP (Uvulopalatopharyngoplasty or "U-triple-P" or "uvulectomy" for short). It is performed by an ear, nose and throat specialist (Otolaryngologist). This procedure will eliminate or reduce snoring in most patients. On the other hand, it relieves obstructive sleep apnea well only if the major obstruction involves only the soft palate. Overall, the UPPP alone will relieve obstruction in about 41% of the cases in which obstructive apnea is a factor over and above snoring. However, the procedure works quite well at relieving simple snoring in a majority of patients since an over-sized soft palate is the most frequent cause of snoring. It is still one of the least expensive, most effective, and simplest forms of surgery to relieve snoring and mild to moderate obstructive sleep apnea.

The procedure involves the removal of parts of the soft palate, the uvula, tonsils and sometimes parts of the sides of the walls of the throat. Although it sounds major, it is a relatively simple surgery lasting under an hour and requiring very little recuperative time. The surgery itself comes in two varieties; "standard surgery" done with cold steel techniques in an operating room under general anesthesia, and "laser surgery" done in the office under local anesthesia. The U-Triple-P, in combination with a anti-snoring device is generally quite effective in treating both snoring and obstruction. Unfortunately, medical insurance rarely covers the U-Triple-P surgery unless a sleep study links the snoring with obstructive sleep apnea.

Download a scientific study (PDF format for Adobe Acrobat Reader)--You must have the Adobe reader Plug-in to download this file

For an excellent scientific study on how well devices like the ones discussed above work when combined with the U-Triple-P surgery, please see this article reprinted from Chest Journal "The Efficacy of Oral Appliances in the Treatment of Persistent Sleep Apnea After Uvulopalatopharyngoplasty". In this study, 24 patients who were unsuccessful in treating their obstructive sleep apnea with the U-Triple-P surgery were later treated with the Herbst appliance. The study assesses their success and is quite honest about the failures as well. It is complex and loaded with technical terminology, as well as statistical analysis, but even those without a scientific background will get a fair idea about how well the combined therapies work.

The GAHM procedure

The newest form of OSA surgery is a major surgical procedure that advances the genial tubercle (a bump on the inside of the tip of the chinbone) along with its associated muscle attachments and the Hyoid bone (the Adams apple). The procedure is called a GAHM procedure (Genioglossal advancement with hyoid myotomy/suspension), and in combination with the UPPP has an overall 61% success rate. The GAHM procedure may be done in conjunction with modifications to the back of the tongue (laser midline glossectomy and lingualplasty) to further open the airway.

Orthognathic Surgery

The Orthognathic solution is a major surgical technique in which both the upper and lower jaws are advanced forward together drawing the tongue and soft palate with them. This option is the most radical, and it does change the overall appearance of the face. It is rarely performed, but it is a very effective treatment for obstructive sleep apnea. The advancement of the mandible can be on the order of 10 to 12 millimeters which is almost certain to relieve the obstruction.

Somnoplasty

Somnoplasty® uses low-power, low-temperature radio frequency energy to treat a well-defined area in the uvula or soft palate. Radio frequency energy is delivered beneath the surface layer of the soft palate. The treated tissue is heated just enough to kill the cells surrounding the electrode. Over the next six weeks to eight weeks, the treated tissue is naturally absorbed by the body, reducing the volume of the tissue and stiffening the soft palate area. Since the delicate surface of the palate is protected, the Somnoplasty® procedure causes minimal pain in most patients, and allows for a quick recovery.

For more information on Obstructive Sleep Apnea, please see the Food and Drug Administration position paper "Breathless no more"

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