Surgery

Studies reporting significant improvement in reduced snoring and less daytime sleepiness for some patients although, as with other surgeries, the benefits may be short term in the majority of patients. It may be helpful for mild obstructive sleep apnea.

Other Procedures

Other surgical procedures may be appropriate to correct facial abnormalities or obstructions that cause sleep apnea. They may be used alone or combined with each other or with UPPP. They include:

• Tongue advancement, in which an opening is cut where the tongue joins the jawbone and the area is pulled forward.
• Genioplasty, which is plastic surgery on the chin.
• Hyoid surgery, in which the movable bone underneath the chin is moved forward, pulling the tongue muscle along with it.
• Maxillary or maxillomandibular advancement (MMA), which moves the upper (maxilla) and/or lower (mandible) jawbone forward. A survey of patients who had MMA found that the surgery changed their facial appearance, but most people thought it was a change for the better.
• Surgery for nasal obstructions (such as a deviated septum) that contribute to snoring and other symptoms.

Removing Adenoids and Tonsils in Children

Adenotonsillectomy, or surgical removal of the tonsils and adenoids, is a first-line treatment for children and adolescents with sleep apnea. It cures the condition in 75 - 100% of cases. Two studies, published in 2005, suggested that adenotonsillectomy can significantly improve quality of life for children with obstructive sleep apnea.

Complications include respiratory illness, which occurs in about 25% of children after the surgery. The highest risk for respiratory complications is associated with:

• Being under 3 years old
• Severe sleep apnea
• Heart complications
• Failure to thrive
• Obesity
• Prematurity
• Recent lung infections
• Certain facial structures
• Neuromuscular disease

The procedure may fail to improve apnea in some patients, such as those with very severe disease. Such children are candidates for continuous positive airway pressure (CPAP) therapy.

Removal of the tonsils and adenoids alone is not an effective treatment for adults with sleep apnea, although the procedure may be effective when combined with UPPP surgery.