Friday, December 10, 2004

Surgery for Obstructive Sleep Apnea

A reader commented on my Dec 8 post on Obstructive Sleep Apnea (OSA):

"Oh man, those CPAPs are uncomfortable. After a few years of use I went for the surgery - they took out my tonsils and did something to my uvula. Didn't help, so I stayed on CPAP. Then I lost 70 pounds. As long as I sleep on my side, I don't need the machine.I don't think the surgey was wasted, though. My cousin was thin as a rail and also needed it."
Uvulopalatopharyngoplasty (UPPP) is the most common surgery for the treatment of OSA. This surgery involves the removal of the uvula, tonsils, and surrounding tissues. It is effective in about 50% of patients. UPPP is usually performed by an ENT physician and is available in most locations.
Other possible surgeries for OSA include genioglossus advancement (surgically moving the tongue forward) and maxillomandibular advancement (breaking the jaw in several places, twisting it, and pulling it forward). These 2 surgeries are only available in specialized centers (Stanford and Atlanta are the 2 locations that I am aware of) and are usually performed by maxillofacial surgeons ( Maxillomandibular advancement is effective in over 90% of patients.
If you are considering sugery for OSA, it is important to work with both a sleep specialist and an ENT surgeon. The ENT surgeon can perform imaging (CT scan or endoscopic examination) of your upper airways to define your anatomy and help predict which surgery you are most likely to benefit from. A sleep study is necessary several months after the surgery to evaluate if the OSA has been cured.
In Mississippi, only UPPP is available. At the University of Missippi Sleep Disorders Center
(, we refer about 1% of our OSA patients to ENT for an evaluation for UPPP. We strongly encourage CPAP as a first-line treatment for OSA.
There is one other surgery for obstructive sleep apnea: tracheostomy ( This surgery is rarely performed in severe cases of OSA refractory to other treatment. It is also perfomed in emergency conditions ( a patient with undiagnosed sleep apnea whose airway collapses after a surgery).


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