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Posts Tagged ‘Surgery

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  The intention of surgery is to open the airway sufficiently to eliminate or to reduce obstructions to a clinically insignificant level. In order to do so, surgical therapy in adults often must reconstruct the soft tissues (such as the uvula and the palate) or the bony tissues (the jaw) of the throat.

If you have been diagnosed with OSA and are considering surgery, talk to a sleep specialist and/or experienced surgeon about the different procedures, and the chances they will be effective to you, with your anatomy and why, and most of all the risks involved with surgery. Untreated sleep apnea can be harmful to your health, and surgery cannot always address all the points of obstruction. Eliminating the snoring does not necessarily eliminate the apneas. Sometimes surgery does not cure sleep apnea but reduces the number of apneas so that more treatment options are available to you and/or more comfortable. Yet in some circumstances, surgery may actually worsen the apnea.Insurance typically covers surgery for sleep apnea but not all surgical procedures. However, insurance companies that initially refuse to pay for a surgery may be convinced otherwise upon an appeal that demonstrates the efficacy and appropriateness of the surgery in your case. Throat pain from the major surgeries varies but is generally significant, often for one to two weeks. Most surgical procedures for sleep apnea are conducted in a hospital under general anesthetic. (People with sleep apnea must be cautious about general anesthesia–no matter for what medical condition the surgery is–because of the effects anesthesia has on the airway.)The most common surgery for sleep apnea is the uvulopalatopharyngoplasty, or UPPP procedure, which is intended to enlarge the airway by removing or shortening the uvula and removing the tonsils and adenoids, if present, as well as part of the soft palate or roof of the mouth. (The uvula is the tissue that hangs from the middle of the back of the roof of the mouth; the word comes from the Latin “uva” meaning “grapes.”) According to the “Practice Parameters for the Treatment of Obstructive Sleep Apnea: Surgical Modifications of the Upper Airway,” issued in 1996 by the American Academy of Sleep Medicine, the overall efficacy is 40.7%. A more recent surgery using a laser (laser-assisted uvulopalatoplasty or LAUP, a modification of the UPPP where the surgeon cuts the uvula with a laser) is performed for snoring. There is not yet enough information to say whether LAUP is effective for OSA. 

There are other surgical procedures where a part of the tongue is removed, and two which try to enlarge the airway by moving the jaw forward. These surgeries do have very high success rates but are long and involved (lasting several hours) with a significant recovery period and potential complications that patients may reject. As a rule, success rates for these complicated surgeries are higher when preformed by an experienced surgeon. You may have to undergo more than one procedure to eliminate the apneas sufficiently. In review, when weighing surgery, consider whether the safety and efficacy of the procedure have met the medical journals and cases studied are similar to yours. Surgery helps many, but effectiveness varies from person to person. It is also highly recommended that with surgery you have follow up sleep studies often, to evaluate your current conditions. If unsure about proceeding, you should seek a second opinion. Only a doctor who has examined you and your airways/complications can advise you on finding the correct surgery best for your needs.

 **Physicians who perform surgery for sleep apneas are most commonly otolaryngologists (specializing in the ears, nose, and throat) and oral and maxillofacial surgeons. If you are seeking a referral to a surgeon or a second opinion, you may find one through your physician or through a sleep center, and keep in mind that your insurance policy may require you to get a referral for a specialist and/or to see a specific provider.**

 

 

 

 

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