Sleep Apnea Surgery

Sleep Apnea Surgery in Iran

Can Sleep Apnea be cured by surgery?

What are the signs or symptoms of sleep apnea?

What are the side effects of sleep apnea surgery?

What is the success rate of sleep apnea surgery?

Pros and cons of sleep apnea surgery

 

Sleep apnea

Sleep apnea is a common sleep disorder which is associated with cardiovascular diseases, diabetes and stroke. Different studies conducted in Iran have reported different prevalence for sleep apnea. The aim of the present study was to determine the prevalence of sleep apnea in Iran. Feeling frustrated with your partner’s constant complaints of your loud snoring at night? You can’t do anything about it while you’re asleep and unconscious, but you can do one thing when you are awake. Sleep apnea surgery is a real solution to your snoring problem.

 

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Can Sleep Apnea be cured by surgery?

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. Just like in children, adults with enlarged tonsils also do better after sleep apnea surgery that includes tonsillectomy. One reason seems to be that the physical removal of the enlarged tonsils immediately opens up space for breathing and improves the sleep apnea.

 

 

 

 

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What are the signs or symptoms of sleep apnea?

The most common signs of sleep apnea are loud snoring, choking or gasping during sleep, and being very sleepy during the day. You may also wake up with headaches or a dry throat, and have trouble concentrating during the day.

sleep apnea diagnosis

Many people never know for sure if they have sleep apnea. Doctors usually can't detect it during routine office visits, and there are no blood tests for it. Most people who have sleep apnea do not really know it because sleep apnea only occurs during sleep.

Doctors diagnose sleep apnea by asking you questions about your medical history and your family's medical past, and performing a physical exam. Your doctor may also want to order a "sleep study" in which your breathing and sleep patterns are monitored.

 

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What is the best surgery for sleep apnea?

There are many different types of surgeries offered to treat obstructive sleep apnea  uvulopalatopharyngoplasty (UPPP),nasal surgeries, and maxillomandibular surgery are the most common.

Surgery - Surgical Procedures

There are many different types of surgery for sleep apnea and snoring. But CPAP is the first treatment option for anyone who has sleep apnea.  Oral appliance therapy also is an alternative treatment option for people with mild to moderate sleep apnea. The members of the sleep team will help you decide if surgery is right for you.

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 physician after surgery.

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Uvulopalatopharyngoplasty:

This mouthful of a word, also known as UPPP, is the most commonly performed surgery for sleep apnea and involves trimming or adjusting the soft palate that sits at the back roof of the mouth to increase the width of the airway. Some people may also have their tonsils and uvula (the fleshy extension that hangs in the back of the throat) removed. While a sore throat is common in the first couple of weeks after surgery, anti-inflammatory pain medications can help ease the discomfort and most people are back at work after just one week.

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Nasal surgery:

Both daytime nasal obstruction and nocturnal nasal congestion have been shown as risk factors for sleep-disordered breathing. Therefore, the treatment of nasal obstruction plays an important role in sleep apnea surgery.  Three anatomic areas of the nose that may contribute to obstruction are the septum, the turbinate’s, and the nasal valve. The most common nasal surgical procedure consists of septoplasty and turbinate reduction.  This is an outpatient procedure that is well tolerated by most patients. It consists of straightening out the septum and reducing the size of the turbinates.  This procedure creates more room in the nose and allows air to pass smoothly and without effort.  For some patients, there is also nasal valve collapse. This is due to weakness of the lower nasal cartilages that hold open the nostrils. For patients who have this issue, the deviated cartilage that is removed from the septum can be strategically placed to strengthen the valve and prevent collapse.

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Uvulopalatopharyngoplasty (UPPP):

This procedure, and other types of soft palate surgery, targets the back of the roof 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.

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Soft palate implants (the Pillar Procedure):

The Pillar Procedure is a minimally invasive approach that can help with snoring and mild cases of sleep apnea. It involves the placement of three polyester rods into the soft palate.  The rods initiate an inflammatory response of the surrounding soft tissues that results in a slight stiffening of the soft palate. The stiffer soft palate is less likely to make contact with the back wall of the pharynx during deep stages of sleep as the muscles relax; snoring and apnea are subsequently reduced.  This procedure can be done under local anesthesia in the clinic with the patient awake.

Hyoid advancement:

Hyoid suspension also known as hyoid myotomy and suspension or hyoid advancement, is a surgical procedure or sleep surgery in which the hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size and improving airway stability in the retrolingual and hypopharyngeal airway (airway behind and below the base of tongue). The horseshoe shaped hyoid bone sits directly below the base of tongue with the arms of the bone flanking the airway. Hyoid suspension is typically performed as a treatment for obstructive sleep apnea (OSA). This procedure is frequently performed with a Uvulopalatopharyngoplasty (UPPP) which targets sites of obstruction higher in the airway. Typically, a hyoid suspension is considered successful when the patient’s apnea-hypopnea index is significantly reduced after surgery.

How does surgery work?

It works by opening up the upper airway. This makes it more stable so it will not narrow and obstruct during sleep. The symptoms of OSA should then get better e.g. snoring, feeling sleepy during the day. Normally, the goal of surgery is just to lessen the symptoms of OSA, not “cure” it.  A second option is surgery on the nose. This is known as “pre phase” surgery. It can be done to help CPAP, oral appliances or other treatments work better.

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What are the side effects of sleep apnea surgery?

Surgery and anaesthetics always carry a risk of side effects. But with more modern types of surgery the risk is low. In most cases, the side effects do not last for long.  Some types of surgery have a greater risk, (e.g. “Laser” surgery).  Your surgeon will discuss all the risks with you in detail. This means that you can weigh up the pros and cons for yourself before deciding whether to proceed.

What is the success rate of sleep apnea surgery?

Surgery, on the other hand, has about a 25% to 30% success rate, and patients with the most severe cases of sleep apnea traditionally are the least likely to eliminate their symptoms.

Pros and cons of sleep apnea surgery

Pros

  • Many types of nasal surgery can often be performed as outpatient procedures under general anesthesia are low risk, and well tolerated If the nasal airway is anatomically tight, limiting nasal airflow, CPAP use becomes more difficult and less well tolerated. Addressing these anatomic abnormalities is frequently necessary in order for CPAP to be tolerated and effective.

Cons:

  • Surgical intervention and recovery is required.
  • Some insurance companies may not reimburse for nasal surgery to treat sleep apnea, claiming these treatments to be medically unnecessary

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10 common questions about Sleep Apnea Surgery in Iran

1What is the success rate of sleep apnea surgery?
Surgery, on the other hand, has about a 25% to 30% success rate, and patients with the most severe cases of sleep apnea traditionally are the least likely to eliminate their symptoms
2What is the new surgery for sleep apnea?
THN Sleep Therapy consists of a minimally invasive, surgically implanted system for patients that suffer from moderate to severe Obstructive Sleep Apnea. The procedure to implant this "sleep apnea pacemaker" is performed by an ENT surgeon, usually as an outpatient procedure with quick recovery time
3Is sleep apnea surgery dangerous?
While all surgeries carry some risks, having sleep apnea can increase your risk of certain complications, especially when it comes to anesthesia. Many anesthesia medications relax your throat muscles, which can make sleep apnea worse during the procedure
4What is the best treatment for sleep apnea?
Positive airway pressure (PAP) therapy is the most common form of treatment for moderate and severe obstructive sleep apnea. To use the PAP system, the patient wears a nasal or full-face mask that delivers pressurized air to the upper airway, preventing the airway from collapsing during sleep.
5Does surgery help sleep apnea?
UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. ... Radiofrequency ablation is a treatment option for people with mild to moderate sleep apnea. It uses controlled cauterization to shrink and tighten the tissues in and around the throat.
6Can a person with sleep apnea have surgery?
In addition, some surgical procedures that require the patient to be flat on their back, typically aren't positions that untreated patients with sleep apnea favor or breathe better in, during sleep. Local anesthesia, by itself, will generally not affect an apnea patient's breathing
7Is sleep apnea surgery painful?
UPPP, or in full, uvulopalatopharyngoplasty, has been the most common sleep apnea surgical procedure performed during the past 25 years. ... This surgery requires an overnight stay in the hospital, as the recovery can be painful for up to one week.
8Can Sleep Apnea be corrected?
CPAP and oral appliances work well, but they're not cures for sleep apnea. The only sure way to rid yourself of the condition for good is to either lose weight or have surgery to remove excess tissue from the palate or throat. Surgery can have side effects, which is why it's usually viewed as a last resort
9How painful is UPPP surgery?
This surgery most often requires an overnight stay in the hospital to make sure you can swallow. UPPP surgery can be painful and full recovery takes 2 or 3 weeks. Your throat will be very sore for up to several weeks. You will get liquid pain medicines to ease the soreness.
10Does removing adenoids help sleep apnea?
Typically, when treating for sleep apnea, both the tonsils and the adenoids are removed to open up the airway and ease breathing.

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