Home » Patients » Surgery
August 2020 |  Reviewed by: Shelley Hershner, MD and Reeba Mathew, MD

What is surgery?

Surgery may be a part of the treatment plan for some patients with sleep apnea or snoring. Your sleep team may recommend surgery if you can’t tolerate CPAP therapy, which is the most effective treatment option for sleep apnea.

Some surgeries are minimally invasive, while others are more complex. The goal of surgery is to treat the areas of the airway that collapse and block your breathing during sleep. Surgery may stiffen, remove or reposition tissues in and around your throat. These surgeries may focus on the:

  • Soft palate and uvula
  • Tonsils and adenoids
  • Tongue
  • Upper and lower jaw

Weight loss surgery may also help treat sleep apnea in patients who are extremely obese.

Treating sleep apnea through surgery is a team effort. Your sleep doctor works with a sleep team to provide the highest quality of care.

The sleep doctor will detect and diagnose your sleep apnea. He or she will perform a detailed examination of the entire upper airway before discussing your treatment options. The doctor may direct you to a surgeon (otolaryngologist) or an oral surgeon (oral maxillofacial surgeon) to perform the surgery. After the surgery is complete, you will need to follow up with your sleep doctor. Typically a repeat sleep study will be done to see if the sleep apnea has improved or resolved.

If you are considering surgery to treat your sleep apnea, make sure to ask your doctor the following questions:

  • What is the success rate of the surgery?
  • How long will it take to recover?
  • How much school or work will I miss?
  • How will this procedure improve my snoring or sleep apnea?
  • Why is surgery a better option for me than CPAP or oral appliance therapy?
  • What are all of the possible risks and side effects?

Surgery is not the right choice for everyone. Some people may benefit more from surgery than others. Side effects of surgery may include:

  • Pain
  • Bleeding and throat swelling
  • Orthodontia and a limited diet for several weeks
  • Overnight hospital stay

In some cases, the benefits may not be permanent and sleep apnea may return.

What are the types of surgical procedures for sleep disorders?

There are different types of surgery for sleep apnea and snoring. Surgery may be a multi-step process involving more than one procedure. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea. It is important to follow up regularly with your sleep doctor after surgery.

Surgical options include:

Uvulopalatopharyngoplasty (UPPP)

This procedure, and other types of soft palate surgery, targets the back of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway.

Upper airway stimulation therapy

Upper airway stimulation involves an outpatient procedure to implant a device that monitors your breathing while you sleep. The device stimulates the hypoglossal nerve, which controls your tongue’s movements, pushing it out of the way to keep the airway open.

To be eligible, patients must have moderate to severe sleep apnea that cannot tolerate CPAP or oral appliance. They also must be at least 22 years old and not significantly overweight. Patients will have to meet with a surgeon to see if this procedure is an option for them. Patients can expect to have a sleep study before and after the procedure.

Radiofrequency volumetric tissue reduction (RFVTR)

In this procedure, the surgeon uses a heated instrument to shrink and tighten the tissues in and around the throat. RFVTR can be used on the soft palate, tonsils and tongue.

Septoplasty and turbinate reduction

These surgical options open your nasal passage to improve air flow. Septoplasty straightens a bent or deviated nasal septum. This is the divider that separates the two sides of the nose. Turbinate reduction reduces or removes the curved structures that stick out from the side of the nose. They can be enlarged for a number of reasons, including allergies. Medications also can help reduce the size of turbinates. This surgery will rarely treat obstructive sleep apnea but may allow more mask options and lower CPAP pressures.

Genioglossus advancement

During sleep the tongue can fall back to block your airway. This surgery moves the major tongue attachment forward, opening up space for breathing behind the tongue. It involves making a cut in the lower jaw where the tongue attaches. This piece of bone (but not the entire jaw) is then moved forward.

Hyoid suspension

This surgery enlarges the space for breathing in the lower part of the throat. The hyoid bone is a U-shaped bone in the neck. The tongue and other structures of the throat like the epiglottis are attached to it. Hyoid suspension involves pulling the hyoid bone forward and securing it in place.

Midline glossectomy and lingualplasty

These two surgeries involve removing part of the back of your tongue. Making the tongue smaller can prevent airway blockage in some people with sleep apnea. These procedures are rare.

Maxillomandibular osteotomy (MMO) and advancement (MMA)

This type of surgery is a treatment option for sleep apnea or patients with a small lower jaw. A small lower jaw can be called retrognathia or mandibular hypoplasia. It moves your upper and/or lower jaw forward to enlarge the space for breathing in the entire throat. The procedures involve cutting the bone of your jaws, which then heal over the course of months. Your jaws may be wired or banded shut for a few days. Your diet also will be limited for several weeks after the procedure. This surgery requires orthodontia to align the teeth to the new bite.

Palatal implants

Palatal implants may be effective in some people with snoring or mild sleep apnea. Small, fiber rods are inserted into the soft palate to stiffen the tissue and prevent airway blockage.

Weight loss surgery

Bariatric surgery can promote weight loss and may improve sleep apnea in people who are extremely obese. Weight loss surgery usually is recommended because of other health risks related to obesity. Prior to weight loss surgery you may be referred to a sleep doctor for an evaluation and sleep study. There are many types of weight loss surgery. Some procedures reduce the size of the stomach, making it harder to eat as much food. Each surgery has different risks and benefits. People who are obese should work with their doctor to implement other weight loss strategies before considering surgery. You should use CPAP before and after weight loss surgery.

Laser-assisted uvuloplasty (LAUP)

This procedure is not routinely recommended as a treatment for sleep apnea. The surgeon makes cuts using a laser to scar and tighten the soft palate. The uvula is trimmed over a period of several visits. It is less painful and has fewer side effects than UPPP. But it is also less effective.

Tracheostomy

This surgery is an effective treatment for sleep apnea. But it is a drastic option that is used in rare, emergency situations. Other treatment options are preferable for almost all patients with sleep apnea. Tracheostomy involves placing a hollow breathing tube directly into your windpipe in the lower portion of the neck. This tube can be plugged during the day, allowing you to breathe and speak normally through your nose and mouth. At night the tube is opened to allow you to breathe without any blockage in your throat.

If you think you may have sleep apnea or need surgery, use the sleep center directory to find an accredited sleep center near you.