Sleep Apnea: aka Tonsillectomy, Septoplasty, Adenoidectomy, Uvulopalatopharyngoplasty
Sleep apnea is a condition resulting in long pauses in breathes while one is sleeping. The term literally means missed breath. Patients with sleep apnea repeatedly stop breathing throughout the night. Because of this they can wake up feeling un-refreshed. Often during sleep apnea a patient will stop breathing for anywhere from 3 to 10-seconds during sleep. This can cause a shift in EEG or brain wave readings and blood oxygen saturation during the evening.
Sleep apnea is typically diagnosed using a special sleep test known as a polysomnogram. Typically episodes of sleep apnea are formally diagnosed when someone misses more than five breathes in one hour repeatedly throughout the night as diagnosed using the polysomnogram.
What Is It?
There are three basic types of sleep apnea: central sleep apnea, obstructive sleep apnea and complex which is a combination of the other two types of sleep apnea. Most people have combination sleep apnea. How do each of these forms of sleep apnea vary?
In central sleep apnea, a lack of effort in respiration cause a pause in breathing. This means a person is not putting enough effort into breathing, although this is not done purposefully, it is the effect of a biological problem or physiological problem.
In obstructive sleep apnea, breathing problems result because something is blocking the flow of air into the body despite adequate effort at respiration. Often people that are overweight experience obstructive sleep apnea. Most people that have sleep apnea do not know they have sleep apnea. They may think they sleep well and wonder why they feel tired during the day. They may experience “micro” sleeps during the day where they fall asleep during brief episodes and do not realize it.
Other people, the people living with them, may realize these minor gaps in wakefulness and bring it to the attention of the individual in question. It is not uncommon for someone with sleep apnea to experience difficulty for years before sleep apnea is properly detected and formally diagnosed. Sleep deprivation is commonly diagnosed in patients with sleep apnea. Serious complications can develop in patients with long-standing sleep deprivation. These may include certain types of heart failure including a type of heart failure known as “Cor pumonale” where right ventricle hypertrophy occurs or where dilation is more prevalent.
Sleep apnea surgery may assist individuals with obstructive sleep apnea. Surgery can help dramatically decrease the risk of certain health risks associated with obstructive sleep apnea including heart attack, depression, stroke and unexplained sudden death. Surgery aims at increasing the airway of patients with obstructive sleep apnea because studies suggest the airway of patients with this disorder is narrower than normal. Upper airway obstruction can dramatically reduce the quality of sleep.
Surgical management typically aims to increase the airway through removal of soft tissue and/or by expanding the jaw if the jaw restricts the airway. Because every patient is unique each approach to surgery will be different.
Some patients will undergo nasal surgery that may include a septoplasty and reduction of the turbinates. These may help reduce the need for the patient to where a special mask called a CPAP at night.
Another surgery is known as an uvulopalatopharyngoplasty. This is among the most common surgery performed among patients with sleep apnea. It involves the removal of the soft palate and other tissues of the throat including the uvula, so that the airway passage is widened allowing more air to pass through the throat, reducing airway obstruction. This can dramatically improve the symptoms and effects of sleep apnea, with success rates reported at 40 percent (approximate). There are however many complications associated with this surgery including complications associated with digestion and heartburn and stenosis.
A similar procedure that is less invasive is known as an uvulopalatal flap surgery, where the oropharyngeal airway is widened by suspending the uvula in a specific way to allow more air to pass through the oropharyngeal airway. This surgery does not rely on the removal of so much soft tissue from the airway.
Several other procedures can be performed to help improve airflow including the maxillomandibular expansion surgery, where the surgeon works to expand the maxilla, which is helpful for improving airflow especially among children and adolescents. This surgery is helpful for people experiencing sleep apnea resulting from obstructed airflow associated with problems arising in the jaw and related areas. This surgery may take place after a patient has worn expanders in the mandible for several months prior to surgery to help facilitate the process. A patient may also wear other orthodontic devices to help improve the airflow and decrease obstruction of air throughout the body.
Alternatives to Surgery
Some patients will fair well wearing a special mask at night that helps open the airway and forces air or oxygen through the airway, known as a CPAP. This mask can be uncomfortable for many however and cumbersome, and may prove only a short-term solution.
Before The Operation
Prior to surgery you will undergo a comprehensive assessment that will include a review of the soft and hard tissues in the airway that contribute to airway obstruction and a review of the jaw and other possible causes for upper airway obstruction. The doctor will undergo a systematic approach in uncovering the best possible approach to improving airflow and evaluating a patient prior to surgery to ensure the best possible outcome.
If a patient has a deviated septum contributing to symptoms the surgery will include correction of this physical anomaly to improve passage of oxygen through the airway. Other problems that may contribute to sleep apnea may include turbinate hypertrophy, elongation of the soft palate, tonsillar hypertrophy and enlargement of the tongue to name a few.
Imaging studies may also help diagnose the exact problem contributing to obstructive sleep apnea so the surgeon can prepare for surgery in the best possible manner.
After The Operation
The recovery from surgery will vary from patient to patient depending on the type of surgery a patient must have and the severity of their condition. Some patients will have to undergo more than one surgery before their condition fully resolves. Most patients will be able to recover for the most part on an outpatient basis, although they will benefit from inpatient care in certain circumstances.
As with any surgery complications may include infection or treatment failure. Surgery is no guarantee that sleep apnea will resolve and some patients may need to continue wearing a CPAP mask even following surgery, although their symptoms may not be as bad.
If you feel you may have sleep apnea be sure to consult with a qualified healthcare provider for an appropriate diagnosis and surgical recommendation.
Estimated Costs for Sleep Apnea Surgery