Surgery for Obstructive Sleep Apnea

Nov 2, 2020 | By Eric J. Kezirian, MD, MPH, Professor of Otolaryngology - Head and Neck Surgery, Keck School of Medic

Surgery for obstructive sleep apnea now includes a wide range of procedures developed to treat the diversity of patients with this condition. Sleep apnea surgery has moved beyond the one-size-fits-all approach that existed when there was just a single procedure to treat all patients. In fact, the evaluation of patients before surgery has become even more important because it is designed to identify the cause of sleep apnea and the right procedures to treat a specific patient.

 

Evaluation of patients considering sleep apnea surgery includes a detailed office examination (often including the use of a flexible telescope to look inside the nose and throat). The challenge is that this and many other tests can be limited by the fact that a patient is awake, while sleep apnea occurs while patients are sleeping. To address this, drug-induced sleep endoscopy involves performing the flexible telescope exam during sedation, so that the surgeon can evaluate the cause of sleep apnea in a state closer to sleep. Drug-induced sleep endoscopy can be helpful for some patients considering surgery and is actually required before patients can be candidates for hypoglossal nerve stimulation surgery.

 

Surgical procedures can address the potential causes of blockage of breathing in obstructive sleep apnea: the soft palate and tonsils, sides of the throat, tongue, epiglottis, or a combination of these. All procedures are designed to open or keep open the space for breathing in the throat. Soft palate procedures generally start with removal of the tonsils if they have not been removed already. In addition, surgery on the soft palate itself can include the traditional approach that removes tissue (often called uvulopalatopharyngoplasty) or can depend more on repositioning of tissue (techniques include expansion sphincter pharyngoplasty or lateral pharyngoplasty).

 

There are many other procedures to remove or reposition other tissues of the throat, whether focusing on the tongue or other structures. These include tongue radiofrequency, genioglossus advancement, tongue stabilization, lingual tonsillectomy, partial glossectomy, hyoid suspension, and partial epiglottis removal.

 

See additional information at https://sleep-doctor.com

 

References1-4

1. Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 2003;113:1961-8.

2. Green KK, Kent DT, D'Agostino MA, et al. Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study. Laryngoscope 2018.

3. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268:1233-6.

4. Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;137:110-4.