Introduction
A sleep apnea is a condition that is manifested through the temporary stops of breathing during sleeping causing low oxygen levels and poor quality sleep. This is a rather frequent condition; around 22 million individuals in the United States of America suffer from it; if undiagnosed and untreated, this condition can lead to high blood pressure, stroke, and heart failure to mention but a few. Since the application of such a device called continuous positive airway pressure is often used in managing patients with sleep apnea, some patients may not do well with this treatment and surgery may be an option. In this article, we will learn about which conditions make a person a candidate for surgical sleep apnea treatment and what the process looks like.
Who Needs Surgical Management of Sleep Apnea?
Sleep apnea surgical treatment should be considered by consulting and being recommended by an expert in a sleep clinic or an ENT doctor. The following are some indications that surgery might be an appropriate treatment option:
1. Ineffective CPAP therapy: If you have attempted CPAP therapy and have intolerated, uncomfortable or ineffective at it surgical treatment may be recommended. There are many people who cannot stand CPAP therapy because of the discomfort on the face, claustrophobia or whatever the may be, meaning they do not receive the right treatment and continue experiencing the effects of sleep apnea.
2. Severe sleep apnea: CPAP therapy is not always the best treatment for those patients with severe OSA because in some instances surgical intervention may be preferable to the use of CPAP mask. AHI is greater than 30 events per hour, and oxygen desaturation ranges from below 80% can have enhanced surgical intervention.
3. Comorbidities: Sleep disorder patients with complicating diseases like heart attack, stroke, hypertension and type 2 diabetes may need a surgical treatment as sleep apnea treatment can make these conditions better.
4. Obesity: The use of weight loss interventions can be considered the initial therapy of choice for OSA, especially in obese patients. However, if weight loss has been difficult or provides poor results then they may opt for surgery.
Different approaches that can be used to treat surgical sleep apnea
In sleep apnea treatment, there are many surgical interventions which address the specific areas of airway in attempt to reduce the obstruction. Some of the most common surgical approaches include:
1. Uvulopalatopharyngoplasty (UPPP): UPPP is a surgery that aims at treating sleep apnoea by reducing the amount of tissue in the throat area, where the uvula and part of the soft palate is removed in order to widen the airway. Some people have reported finding relief from their snoring as well as from their sleep apnea after this procedure.
2. Nasal surgery: Some people’s noses are naturally more narrow than others leading to sleep apnoea, though there are procedures that involve rearranging the structure of the septum to allow for a proper passage for air in a patient’s nose which can address the issue of surgery for sleep apnoea.
3. Maxillofacial surgery: These procedures include surgery to the jaws, palate, and related soft tissues with an intention of restructuring the airway passages and eliminating obstructions. Two of the surgical procedures are mandibular maxillary advancement (MMA) and genioglossus and hyoid advancement (GHA).
4. Radiofrequency tissue ablation: This nonsurgical technique employs heat generated by an electrical current to ‘shrink’ or remove a portion of the palate or tongue that is blocking airways.
5. Tracheostomy: Tracheostomy is the surgical process of making a small hole on the neck to ensure direct breathing through the lungs not through the oral or nasal cavity. It is done only in the cases of where the patient has severe life threatening sleep apnea and has not responded well to other treatments.
What You Need to Know About Sleep Apnea Surgery
1. Evaluation and diagnosis: Cognitive behavioral therapy is recommended to include specific studies from a sleep specialist and surgeon before the surgery. This may require physical assessment, polysomnography to establish the type of sleep apnea and the original surgery, CT scan or MRI to support the surgical plan.
2. Pre-operative preparation: Some of the things that your surgeon will tell you not to take before the surgery will include food and specific medicines, and he or she will recommend that you undergo a thorough medical assessment before undergoing the procedure. You may also be asked to have other procedures including blood tests, or if your case is severe, a cardiac test.
3. Surgery: Surgical treatment of sleep apnea can be carried out either by local or general anesthesia, based on the surgery done. Depending on the type of the intervention and its complexity, it may take few hours or many, as may also the period of hospitalization. The patient can go home immediately after the surgery or within several days after the surgery at the most.
4. Post-operative care: Healing from the surgical sleep apnea treatment may take a different course depending on the particular surgery and the patient’s characteristics. Someone may have some pain, swelling or bruising in the treated area depending on where the surgery was conducted, normally this is controlled by pain medications and application of ice on the treated area. You have to wear the recommended dressing and follow the diet, movement restrictions and schedule of follow-up appointments given by your surgeon.
5. Follow-up and sleep studies: After the surgery, other sleep studies will be recommended to establish the success of the surgery in managing sleep apnea. Based on your circumstances, your surgeon and sleep specialist will evaluate how to proceed with any more treatment or change of the procedure.
Conclusion
Surgical treatment of sleep apnea is a viable option for severely obese patients with moderate to severe sleep apnea who have either failed or refused CPAP therapy or have specific comorbidities that may benefit from airway surgery. This approach is an important consideration in sleep apnea treatment, but it requires consultation with specialists in sleep medicine and detailed discussions with the surgeon. It’s crucial to evaluate whether surgery is feasible based on the individual’s condition and to have realistic goals and expectations about the outcomes and potential side effects of the procedure.