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Should I have surgery to treat obstructive sleep apnea?

Should I have surgery to treat obstructive sleep apnea?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

If you do not treat obstructive sleep apnea (OSA), it can cause several problems. If you have sleep apnea, you may be at risk for excessive daytime sleepiness and complications such as high blood pressure, high blood pressure in the lungs (pulmonary hypertension), depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

Consider the following when making your decision:

  • You should try continuous positive airway pressure therapy (CPAP) before trying any type of surgery. Most experts do not suggest surgery for sleep apnea unless you have tried CPAP first.
  • You may consider surgery as initial treatment if a blockage is clearly reversible, such as from having overly large tonsils, or if you are at high risk for developing complications from sleep apnea.
  • You might still need CPAP after uvulopalatopharyngoplasty (UPPP) surgery. There is no good evidence on how well this surgery works for sleep apnea.1 Limited research shows that about 40% to 60% of people who have UPPP see an improvement in their symptoms.2
  • If you are extremely overweight (severely obese), you might think about bariatric surgery to help you lose weight. Losing weight may improve sleep apnea symptoms or end them completely.3
  • Tracheostomy almost always cures sleep apnea that is caused by blockage of the upper airway. But you are at risk for many complications, and you may worry about how you will look after surgery. Other treatments are nearly as effective as tracheostomy in most people.

Medical Information

What is obstructive sleep apnea?

Sleep apnea occurs when you regularly stop breathing for 10 seconds or longer during sleep. It can be mild, moderate, or severe, depending on the number of times an hour that you stop breathing (apnea) or that air flow to your lungs is reduced (hypopnea). Apnea episodes may occur from 5 to 50 times an hour.

What causes obstructive sleep apnea?

A blockage or narrowing of the airways in your nose, mouth, or throat generally causes obstructive sleep apnea (OSA). This usually occurs when the throat muscles and tongue relax during sleep and partially or completely block the airway.

Sleep apnea can also occur if you have bone deformities or enlarged tissues in the nose, mouth, or throat. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.

Other factors that make sleep apnea more likely include using certain medicines or alcohol before bed, sleeping on your back, and being obese.

If you need more information, see the topic Sleep Apnea.

Your Information

You have the following choices:

  • Use continuous positive airway pressure therapy (CPAP). CPAP uses a machine that helps you breathe more easily during sleep. The machine increases air pressure in your throat so that your airway does not collapse when you breathe in. Your using CPAP may also help your bed partner sleep better. See a picture of CPAP Click here to see an illustration..
  • Have uvulopalatopharyngoplasty (UPPP) surgery. UPPP removes excess tissue in the throat to make the airway wider. Widening the airway sometimes can allow air to move more easily through the throat. In adults, this is the most common surgery to treat obstructive sleep apnea.
  • Have bariatric surgery if you are extremely overweight. During bariatric surgery, the doctor reduces the size of your stomach to help you lose weight. Losing weight may improve sleep apnea symptoms or end them completely.3
  • Have tracheostomy surgery. In this procedure, the surgeon creates a permanent opening in your neck to your windpipe (trachea). He or she then puts a tube in the opening to help you breathe at night. Tracheostomy almost always cures sleep apnea that is caused by blockage of the upper airway.

The decision about whether to have surgery for obstructive sleep apnea takes into account your personal feelings and the medical facts.

Deciding about treatment for obstructive sleep apnea
Treatment Reasons to use this treatment for sleep apnea Reasons not to use this treatment for sleep apnea

Continuous positive airway pressure (CPAP)
  • You should try CPAP before any surgery.
  • CPAP decreases daytime sleepiness, especially in people who have moderate to severe sleep apnea.4, 5
  • Small studies indicate that CPAP improves both daytime and nighttime blood pressure.6, 7
  • CPAP can be uncomfortable, which causes many people to stop using it.
  • Side effects include nightmares, dry nose and nosebleeds, and headaches.
  • CPAP may not be effective if you have mild sleep apnea.5
  • You need to see your doctor regularly for adjustments.

Uvulopalato- pharyngoplasty (UPPP)
  • You have a reversible condition, such as having overly large tonsils.
  • You are unable to or you choose not to use CPAP to treat your sleep apnea.
  • You have tried CPAP, but it has not reduced your symptoms.
  • There is no good evidence on whether UPPP works for sleep apnea.1
  • The procedure may stop your snoring, but apnea episodes may continue.8
  • Limited research indicates that in about 40% to 60% of people who have UPPP, symptoms improve.2
  • You may still need CPAP after surgery.

Bariatric surgery
  • You are extremely overweight (obese) and have not been able to lose weight with diet and exercise.
  • Weight loss after surgery can cure sleep apnea.3
  • Losing weight can improve your overall health and lower your risk of other diseases such as diabetes.
  • You are not extremely overweight.
  • Any type of surgery has a risk of complications.

Tracheostomy
  • A tracheostomy nearly always cures sleep apnea.

Risks may include:

  • Formation of scar tissue at the opening.
  • Difficulty speaking.
  • Bleeding or infection at the opening.
  • Increased risk of lung infections.
  • Emotional problems, such as change in self-image and depression.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for sleep apnea. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have tried CPAP but it does not help.

 Yes No Unsure

I have tried CPAP. It helps, but I am uncomfortable with it and I rarely use it.

 Yes No Unsure

I understand that even after uvulopalatopharyngoplasty, I may need CPAP.

 Yes No Unsure

I am extremely overweight and would like to lose weight.

 Yes No Unsure

I am able to lose weight through diet and exercise.

 Yes No Unsure

My appearance after a tracheostomy-having a hole in my throat-does not bother me.

 Yes No Unsure

I understand the potential complications of a tracheostomy.

 Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for obstructive sleep apnea.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery for obstructive sleep apnea

Leaning toward NOT having surgery for obstructive sleep apnea

Return to the topic Sleep Apnea.

References

Citations

  1. Sundaram S, et al. (2006). Surgery for the treatment of obstructive sleep apnoea. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

  2. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611-630.

  3. Buchwald H, et al. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14): 1724-1737.

  4. Giles TL, et al. (2006). Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

  5. Hensley M, Ray C (2006). Sleep apnea. Clinical Evidence (15): 1-18.

  6. Pepperell JC, et al. (2002). Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised study. Lancet, 359(9302): 204-210.

  7. Becker HF, et al. (2003). Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation, 107(1): 68-73.

  8. Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360(9328): 237-245.

Author: Maria G. Essig, MS, ELS Last Updated: July 13, 2007
Medical Review: Caroline S. Rhoads, MD - Internal Medicine
Jan Ulfberg, MD, PhD - Sleep Disorders
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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.


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