I have sleep apnea that has only gotten worse since I was first diagnosed with it. I'm really sick of having to worry about it all the time, so I'm wondering at what point I should considering having surgery to take care of my sleep apnea. How serious does my sleep apnea have to be before I should consider surgery? What are the risks of having surgery? How much more effective than machines is surgery?
Doctors Answers (2)
Surgery for sleep apnea is reserved for patients who are felt to benefit from such intervention. Surgeons who have become conservative in their selection of patients to perform use many factors to assist in their decision to operate. These factors include the severity of the apnea, the compliance of CPAP therapy, the cardiovascular consequences of the apnea and the anatomy of the patient. Some patients may benefit from removing their tonsils and part of the soft palate and tongue. Some patients are candidates for moving the mandible forward. Less rare today compared to 25 years ago, a tracheotomy is the only solution. A new surgical procedure involves placing an electrical stimulator into the base of the tongue, which is activated to move the tongue out of the obstructed airway. This stimulator is awaiting FDA approval. A select group of patients are felt to be candidates for this procedure, depending on a careful examination of the airway. CPAP therapy is still considered the treatment of choice and is more effective than surgery for the vast majority. The risks of any of the surgeries are the same as surgery for any reason, but removing part of the soft palate may result in an annoying escape of liquids into the nose while trying to swallow.
Surgery is not typically more effective than CPAP. The worse the sleep apnea, the less likely surgery will alleviate it. If you are determined to have surgery, repeat the overnight sleep study after you have healed post-operatively. The post-surgery sleep study will determine if sleep apnea is still present. All surgeries carry risks, and those risks should be discussed in depth with the ENT surgeon who is operating on you. If you wear your CPAP set at the correct pressure, with a correct fitting mask, then the sleep apnea is alleviated.