Surgery for Obstructive Sleep Apnea

Surgery for obstructive sleep apnea (OSA) is an effective adjunct or helper for other treatments. It is a common misconception that surgery cures OSA. While it can achieve cures, often times after years, the problem returns. However, the problem is not usually as bad as before. Surgery is very effective for controlling the symptom of snoring. It is possible to alleviate the snoring and continue to have obstructive apnea events during sleep and thus still have a significant health problem.

The basic problem with OSA is that the throat collapses when a person is sleeping. This collapse of the throat leads to the symptom of snoring. In OSA patients, the snoring is often extremely loud and disturbs family members. When you sleep, the muscles relax, and this allows the throat to collapse to the point it can close off, thus causing the breathing problems. Most people are able to maintain some degree of opening in the airway during sleep. The obstruction usually takes place in one of two areas. It can occur in the velum (follow the roof of the mouth backward until it reaches the back of the throat), or in the lower oropharynx (behind the back of the tongue).

Surgery for sleep apnea cannot be looked at as a quick fix. We regard this surgery as a stepwise approach toward the goal of either curing the sleep apnea, or making it more manageable. One of the most effective, and the preferred method for treating OSA is nasal CPAP. If you are reading this, you have probably tried nasal CPAP. It is the second most effective means for treating sleep apnea, the most effective being tracheostomy. Many people cannot tolerate the CPAP for a variety of reasons. Some of those reasons can be helped by surgery. Other means of treating sleep apnea are weight loss and various devices that can be worn during sleep.

CPAP achieves its effect by inflating the throat during sleep. In this way, it alleviates the obstruction that occurs. It requires pressure to do this. In some patients, the pressure requirement can be so great the CPAP mask is very uncomfortable to wear.

Surgery achieves its results by physically removing or shrinking tissue in the throat in an attempt to enlarge the airway. The first step in surgical treatment involves removing the tonsils and trimming away the tissue in the palate area (posterior roof of mouth). The overall cure rate for this first procedure is around 40%. Patients with more severe apnea have a worse prognosis, and those with milder OSA have a better prognosis. This procedure is very painful. The severe pain usually lasts 7 to 10 days. After this time, the pain begins to get better, and improves over the following 2 to 3 weeks.

In addition to pain, this surgery can cause a hypernasal voice, and problems with food/liquids going into the back of the nose when swallowing. It is also possible to have a hemorrhage a week after surgery if the tonsils need to be removed. This procedure may be performed in conjunction with other surgeries to open the nasal passages, and/or shrink the tongue muscle.

Cure of OSA is defined as being able to sleep without the need for a CPAP device. More often, the surgery is effective by allowing us to decrease the pressure in the CPAP device enough that it can be tolerated better, even though it is still necessary. The 2nd step, if necessary and desired, involves advancing the tongue forward. It is much less painful than the 1st procedure.



POST OPERATIVE INSTRUCTIONS:

1. Normal activity can be resumed after the first week depending on the patient’s comfort level. For the first week there should be no heavy lifting or exertion.


2. Diet: You may have soft foods such as oatmeal, soups, pureed fruits and vegetables, jello, ices and ice cream in the first few days following surgery. Avoid hard foods that cause straining or pain. It is extremely important that you drink sufficient water/liquids to avoid dehydration. You should drink at least six glasses of water each day. Sufficient pain medicine should be administered if pain is preventing you from taking in enough fluids. You may not want to take in any food -- this is acceptable.


3. It is necessary to keep the mouth and teeth clean after a throat operation. The teeth should be brushed gently two or three times a day.


4. Many patients complain of earache after a throat operation. This is normal and frequently the ear pain is worse than the throat pain. This pain is coming from nerve fibers in the throat. This is not an ear infection. Usually the pain is most intense on the third to sixth postoperative day.


5. Some fever is expected. If it is over 102 degrees F, call my office. There will be a white covering/scab where the tonsils were. This is normal.


6. It is expected that there will be some bloody secretion. Should there be a significant amount of bright red blood call our office immediately. If the phone is answered by the answering service, the doctor will be notified immediately. Should there be any problem or difficulty with contacting the doctor, report to the emergency room. The emergency room physician will have to see you in this situation and contact the covering surgeon as necessary.


7. Call the office for an appointment two weeks following surgery. School or work may resume as your energy level increases. This is usually one to two weeks after surgery. It is not unusual to have difficulty swallowing, throat discomfort, and a feeling that there is something in your throat for several months after the procedure.


8. Medication for pain: Tylenol and prescription pain medication as prescribed by your physician


9. Call our office for any concern post operatively