by Elspeth Raisbeck

Created on: August 30, 2011   Last Updated: August 31, 2011

Surgery for Sleep Apnea.

Sleep apnea occurs when the soft tissues of the soft palate at the back of the mouth and/or the tongue collapse when you’re asleep.  They block the airway and mean you stop breathing until the brain detects this and wakes you up.

If it happens for about 10 seconds, more than 10 times each hour, doctors describe this as ‘clinically significant’ and it can affect your health.  It can cause changes in mood, such as depression; tiredness and lethargy; memory problems; morning headaches; low libido and erectile dysfunction (impotence); high blood pressure and heart problems including abnormal heart rhythms and heart failure.

Surgery for sleep apnea is always a last resort if you have tried sleep apnea pillows or sleep apnea mouthpieces and found they haven’t solved the problem.

There are several options for surgery and we’ll look at these here.

First though, your doctor will want to find out where the problem is coming from – is it the tongue or the soft palate.  This will help determine what sort of surgery is best for you.  It is done by nasendoscopy, where a person is given a sedative and a small camera is passed into the nose and back of the throat.  The surgeon can then see which and where the tissues are collapsing when you sleep.

Surgery for the soft palate.

If the soft palate is floppy and causing the blockage in the airway when you sleep there are several options for sleep apnea surgery.

Uvulopalatopharyngoplasty (say oovulo-pallaytoe-farr-ingoe-plasty) or UPPP.

Laser assisted uvulopalatoplasty (LAUP) – laser surgery for snoring.

Palatial stiffening operations (CAPSO).

 Pillar Procedure.

These procedures are described below.  They sound a bit gruesome and like major surgery but are actually easily done in the outpatient clinic.

UPPP is probably the commonest surgery for sleep apnea and involves removing the tonsils, uvula (the piece of skin that hangs at the back of the throat) and the back edge of the soft palate. 

The LAUP procedure uses a carbon dioxide laser to remove the uvula and it normally requires up to 5 sessions of this laser surgery for sleep apnea to solve the problem.

CAPSO burns the soft palate with controlled electrical cautery.  The tissue then heals but is stiffer than normal (this is called fibrosis) and, as it’s less floppy, it is less likely to block the airway as you sleep.

Pillar procedure is also quite common and used in mild to moderate sleep apnea.  Three very small pillars, made of a woven surgical material are put into the soft palate to make it stiffer and better supported.  It’s also good for snoring.

Surgery for the tongue.

Where the tongue is falling backwards and blocking the airway, a procedure called Repose or the Tongue Suspension Procedure can be done.  It involves putting a small screw into the lower jaw.

Other surgeries will reduce the volume of the tongue or repositioning the lower jaw by lifting it forward.  It is then held in place by a bone graft and plates.  This technique is called maxillary-mandibular advancement.  When the jaw is a better shape it can better support the soft tissues and the sleep apnea should stop or be greatly reduced.

There are several potential problems with surgery for snoring or sleep apnea, but your specialist will discuss these in detail so that you are fully aware.

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