Obstructive Sleep Apnea Surgery

Increased nasal congestion has been shown to cause or contribute to snoring, disrupted sleep, and even sleep apnea. Nasal obstruction may result from many causes including allergies, polyps, deviated septum, enlarged adenoids and enlarged turbinates. 

Structural problems, such as a deviated septum​, often benefit from surgical treatment. One surgical option, known as radiofrequency turbinate reduction (RFTR), can be performed in the office under local anesthesia. RFTR uses radiofrequency to shrink swollen tissues in each side of the nose. 

In many patients with obstructive sleep apnea, airway narrowing and collapse occurs in the area of the soft palate (back part of the roof of the mouth), tonsils and uvula​. The specific type and combination of procedures that are indicated depend on each individual’s unique anatomy and pattern of collapse. Therefore the procedure selection and surgical plan are customized to each patient. In general, these procedures aim to enlarge and stabilize the airway in the upper portion of the throat.    

The surgery is performed in an operating room under general anesthesia, either as an outpatient or with an overnight hospital stay. The recovery varies depending on the patient and the specific procedures performed. Many patients return to school/work in approximately one week and return to normal diet and activity at two weeks. Throat discomfort, particularly with swallowing, is common in the first two weeks and usually managed with medications for pain and inflammation. Risks include bleeding, swallowing problems, and anesthesia complications, although serious complications are uncommon.    

The tonsils and adenoids may be the sole cause of snoring and sleep apnea in some patients, particularly children. In children, and in select adults, with obstructive sleep apnea and enlarged tonsils/adenoids, tonsillectomy/adenoidectomy alone can provide excellent resolution of snoring, sleep apnea and associated symptoms.​   

The lower part of the throat is also a common area of airway collapse in patients with obstructive sleep apnea. The tongue base may be larger than normal, especially in obese patients, contributing to blockage in this area.  The tongue may also collapse backward during sleep as the muscles of the throat relax, particularly when some patients sleep on their back.  The epig​lottis, or upper part of the voice box, may also collapse and contribute to airway obstruction.   

Multiple procedures are available to reduce the size of the tongue base or advance it forward out of the airway. Other procedures aim to advance and stabilize the hyoid bone, which is connected to the tongue base and epiglottis​.  A more recent technology involves implantation of a pacemaker-type device under the skin of the collar bone that omits mild electronic stimulation to the upper airway – the main nerve on the tongue – during each breathing cycle. As with surgery of the palate, the most appropriate type of procedure varies from one individual to another, and is primarily determined by each patient’s anatomy and pattern of obstruction.    

The procedures are done under general anesthesia, often with overnight hospital observation. Recovery and risks vary depending on the procedure(s) performed, but are generally similar to procedures in the upper throat.