A Guide to Obstructive Sleep Apnoea Treatment
by the Melbourne ENT Group
What is Obstructive Sleep Apnoea?
An estimated 24% of men and 9% of women suffer from a condition called obstructive sleep apnoea. This is a medical condition that has a variety of consequences including daytime sleepiness, impairment of normal brain function and a poorer quality of life. It is also known to contribute to blood pressure, risk of heart attack and stroke, and other complications.
It involves the collapse of the upper airway during sleep, forcing the body to become more ‘awake’ to restore normal breathing. These constant disruptions or ‘arousals’ and chronic low oxygen at night understandably can have exhausting physiological and psychological consequences for the body and greatly reduce quality of sleep.
There are many excellent non-surgical treatments for obstructive sleep apnoea. You may have heard of CPAP machines, which provide pressure to help prevent the airway from collapsing in this way. These can be effective at times, but not all people find them to be the best solution.
Mandibular advancement splints are another effective form of minimally invasive treatment for sleep apnoea, but again, may not be appropriate for or tolerated by all patients. For these people, surgery can be a viable and effective alternative, and help reduce the likelihood of the airways closing up and collapsing, thus improving snoring and sleep apnoea severity.
Why choose sleep apnoea surgery?
First line treatment for sleep apnoea is often using a CPAP machine or other devices, but these can be uncomfortable, bulky and may not work for everyone. Surgery can be performed to open up the upper airway, targeting the parts of the breathing system that can narrow and collapse resulting in the condition. This often reduces the symptoms associated with sleep apnoea, making it easier to manage and live with on a daily basis.
What kinds of problems can sleep apnoea surgery treat?
- Sleep apnoea in children, where surgery is often a first line treatment
- Structures in the body causing sleep apnoea, such as large tonsils
- Physical conditions that make it hard to use a CPAP device, such as nasal obstruction
- Situations where you have tried CPAP and either do not find it effective, or do not want to need to wear one.
Sleep apnoea surgery is a popular surgery because it offers a variety of benefits for those that need it. Some of these benefits include:
- Quality of life. Sleep is incredibly important to daily functioning, energy levels and overall quality of life. Missing out on good quality sleep can affect people in every aspect of their life, and in the case of sleep apnoea this is a regular and exhausting occurrence. Treatment with surgery can help reduce or prevent these periods of apnoea, letting you get on with your life.
- Snoring. Compared to the fatigue and the feeling of never quite getting a full night’s rest with sleep apnoea, snoring may not seem like much of a problem at a glance. But to family and partners of people with sleep apnoea, this is often the most obvious impact on their own lives. The energy that goes into making audible snoring is also part of what makes sleep apnoea so fatiguing and can reflect how bad the condition is. Surgery helps open up the upper airway, preventing them from narrowing and closing up during sleep.
- Freedom. Wearing a CPAP machine is rarely described as comfortable. The need to keep a machine on one’s person every night, even when away on business or holidays, can be exceedingly difficult or even impossible for many people. Surgical treatment in the right situations can reduce or even eliminate the need for keeping and maintaining an expensive machine, with the added benefit of breathing naturally without any masks or tubing.
- Cost effective. Studies performed on patients with severe sleep apnoea who could not tolerate CPAP machines have found that choosing surgery for this condition is cost effective, and reduces the risk of stroke, cardiovascular disease and motor vehicle accidents.
What are the risks of sleep apnoea surgery?
Every significant surgery carries risks, including infection, bleeding and adverse reactions to anaesthesia. Risks specific to sleep apnoea surgery include:
- Sleep apnoea risks. Due to the way sleep apnoea works, having this condition increases the risks of certain complications, especially anaesthetic risks during the operation, and in the first 24-48 hours afterwards. In addition, many medications used in general anaesthesia relax the airway and throat muscles, which make the condition worse and you may need to have extra breathing support after the procedure. Of course, the surgery is intended to improve your sleep apnoea so your future risks of anaesthesia are potentially reduced by this surgery.
- Risks specific to type of surgery. A wide variety of surgeries are available for sleep apnoea, so different parts of your upper airway may be targeted to optimise your breathing. These carry risks specific to the area being operated on – for example, if the tongue reduced in volume to increase airway space there is some risk of damaging nerves or blood vessels in the tongue, leading to sensation changes or swelling respectively. Your surgeon will detail your options and those which best suit you and will explain specific risks involved with surgeries you may wish to choose from.
Is it easy to perform sleep apnoea surgery?
As this kind of surgery involves the upper airways, it is not surprising that your surgeon needs to be extremely careful when performing surgery. These are some of the key considerations your surgeon will need to make about your unique situation:
- Varying anatomy. Every person is different in their breathing pathways and unique situation. Your surgeon will need to take into consideration the way your soft tissues (tonsils, palate, tongue and similar structures) and ‘hard’ tissues (nasal septum, jaw, teeth) are positioned in the airway to determine an approach that will give you the best possible results.
- Complexity of surgery. A wide variety of surgeries are offered for sleep apnoea, which can include removing the tonsils, excess tissue from the palate and pharynx (the space combining your nose and mouth), and altering the position of the tongue and hyoid bone (the top part of the Adam’s apple). Increasingly, implantable pacing devices for certain nerves and muscles of the airway are also being used. These may be performed individually or in combination to optimise your outcomes.
- General anaesthesia is usually needed for surgery. Being a major surgery involving the neck, sleep apnoea surgery often requires the anaesthetist to use general anaesthesia. This means you will be unconscious for the surgery, which many people prefer, but understandably requires more resources to best look after you during the procedure.
Can you go home soon after sleep apnoea surgery?
In some cases, yes. Sleep apnoea surgeries are almost always performed under general anaesthesia, so some observation time is needed to ensure you have recovered fully. Some procedures are minimally invasive, such as using implants to help stiffen the airway, and can be done in a day surgery setting allowing you to head home the same day.
However, some more detailed surgeries often need an overnight stay to aid in recovery and optimal healing, but rarely require more than a 2 night stay. Your procedure will be tailored to suit your unique situation, so talking with your surgeon will help you get the best picture of what to expect.
How long does it take to recover from sleep apnoea surgery?
Most patients who have sleep apnoea surgery can get back to their regular activities of daily living as soon as they get home. As surgery involves the upper airway and sometimes the neck region, it is usually not difficult to move around and do most things you would normally do in a day. It is important to avoid strenuous activity for up to three weeks, depending on the surgery, as this can increase swelling or bleeding in some sleep apnoea surgeries.
The amount of pain following surgery will vary considerably depending on which type of surgery you decide with your surgeon is best. Much like having tonsils removed, pain can be present for two to three weeks after major surgery involving the palate, uvula and tonsils. Swallowing may be difficult and painful in the period after surgery, so hard and dried foods are best avoided. In these cases, you will be provided with effective pain medication and an outline on how best to manage this, and this pain usually improves after this time.
By comparison, some surgeries are minimally invasive and are done in less than an hour. With these surgeries, many people are back to their normal selves in a day or two. Your surgeon will balance the level of surgery with the severity of your obstructive sleep apnoea condition and risk factors, in order to achieve the best outcome for you.
For the right patient, sinus surgery can be a great option for 5 reasons:
- To significantly improve sleep quality by reducing or preventing periods of apnoea
- To prevent snoring by opening up the upper airway
- To reduce or eliminate the need for using, keeping and maintaining a CPAP machine
- To reduce fatigue and improve overall quality of life
- To provide a cost-effective solution that reduces the risk of stroke and cardiovascular disease