DEAR MAYO CLINIC: I used to be recognized with obstructive sleep apnea and was prescribed a CPAP machine. Nonetheless, it doesn’t appear to be serving to. My physician stated we must always contemplate surgical remedy. What are the widespread surgical choices to deal with obstructive sleep apnea, and what’s the restoration like for a majority of these operations?
ANSWER:
is a dysfunction the place sleep is disrupted by a scarcity of excellent airflow by your respiration passages — your mouth, nostril, throat — throughout sleep. Folks with this dysfunction not solely undergo from lack of restorative sleep. Additionally they are prone to many medical issues, together with hypertension, heart problems and stroke, in addition to occupational or vehicular accidents. Obstructive sleep apnea is widespread, affecting an estimated 20-30 million individuals within the U.S.
First-line remedy for obstructive sleep apnea is a few type of constructive airway stress, generally referred to as
. This works by supporting the tender tissues of the airway throughout sleep. Sadly, there are a lot of individuals who don’t tolerate it effectively attributable to problems with claustrophobia, air passing into the abdomen or facial shapes that don’t permit a
.
Happily,
there are surgical options available
for such sufferers. The choice to desert constructive airway stress remedy shouldn’t be made flippantly, although, nor earlier than a affected person actually tries to tolerate CPAP.
Changes in pressure delivery, mask fit and other techniques
usually could make CPAP extra tolerable and CPAP remedy profitable. Work together with your sleep specialist to ensure you have exhausted all nonsurgical choices, as a result of surgical procedure carries threat.
Many surgical choices try to both take away further airway tissue that collapses throughout sleep or assist the tissues in a means that helps you breathe higher.
The easier operations are tender tissue surgical procedures within the nasal, oral or throat areas that take away or reposition tissues. These usually are outpatient surgical procedures so you possibly can go dwelling the identical day. Relying on what is finished, restoration often includes administration of ache; wound care, resembling nasal or oral rinses; short-term dietary modifications; and maybe per week or so off work.
As a result of these are smaller operations with decrease morbidity, they’re typically most helpful in instances of delicate or average obstructive sleep apnea, and their success charges total are decrease than extra concerned surgical procedure. Nonetheless, as soon as healed, sufferers don’t want to make use of a machine or different gadget at night time.
One other more moderen possibility is the usage of a nerve stimulator to assist the tongue and palate muscle mass keep open throughout sleep. A hypoglossal nerve stimulator is a bit bit like a pacemaker on your airway. It makes use of a small battery pack underneath your chest pores and skin with sensors to detect if you breathe in at night time and leads that stimulate your airway muscle mass to remain open. This gadget is implanted surgically and activated by sufferers after they fall asleep.
Restoration is just like that with tender tissue surgical procedures, and sufferers can return to work fairly shortly. The influence on weight-reduction plan and problems with wound care are lower than with tender tissue surgical procedure. This could be a very helpful possibility in some sufferers and is very profitable, however there are some restrictions, together with physique weight and severity of obstructive sleep apnea, that remove some sufferers as candidates.
Lastly, some sufferers with extreme illness or weight problems who usually are not candidates for the extra minor operations could also be candidates for surgical procedure on the facial bones themselves. These surgical approaches transfer the bony attachments of the tender tissues to a place the place the airway stays open at night time. These operations are helpful in sufferers with facial bone improvement issues, resembling a retruded decrease jaw or chin, as a result of these sufferers are at a lot increased threat for tender tissue collapse.
Bony surgical procedure repositions the decrease jaw to the place it ought to have had extra regular development. These bony operations are extra concerned, often require a one- to two-night hospital keep, and have extra influence on sufferers attributable to weight-reduction plan and exercise restrictions, swelling and typically modifications in facial look (often constructive). Curiously, these surgical procedures are much less painful than tender tissue operations. They’re extremely profitable and don’t require any effort on the a part of the affected person after surgical procedure.
Figuring out which surgical choices are applicable for anybody affected person
requires a thoughtful approach
— every affected person is exclusive. However it’s essential that you’ve got long-term remedy of your obstructive sleep apnea to keep away from medical or different issues sooner or later. —
, Oral and Maxillofacial Surgical procedure, Mayo Clinic, Rochester, Minnesota
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