Although continuous positive airway pressure (CPAP) is recognized as the best treatment for obstructive sleep apnea, it is a treatment that's not always well tolerated.
If you are one of the many individuals who struggle with CPAP therapy, you should know that alternative treatment options do exist. For example, the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine recommend oral appliance therapy for those who are intolerant to CPAP therapy.
Exercise in patients with obstructive sleep apnea has shown improved clinical outcomes. Surgical intervention including tonsillectomy is another potential option to improve sleep apnea symptoms.
How tonsils affect sleep apnea
Enlarged tonsils can block your airway when you sleep, interfering with your breathing. Tonsils may be enlarged due to:
- Virus-related swelling
- Infection-related swelling
Studies have found that although tonsil volume decreases as we age, tonsil volume increases as body mass index (BMI) increases. This has contributed to the recognition of BMI and obesity as being among the biggest predictors of OSA.
How sleep apnea affects the tonsils
The vibrations and stretching associated with snoring can lead to inflammation of the tonsils and nerve lesions, contributing to (and exacerbating) OSA symptoms.
Furthermore, heavy snoring and OSA is linked to weight gain. Therefore, OSA caused by a high BMI can lead to a vicious cycle of increasing weight gain and worsening OSA symptoms.
Could a tonsillectomy be the answer?
A 2016 systematic review published in Laryngoscope found tonsillectomies led to a:
The review found those most likely to benefit from a tonsillectomy had a preoperative BMI of less than 30 and AHI below 30 per hour. This suggests that those who have sleep apnea due to obesity or a more severe disease, are less likely to benefit.
A tonsillectomy alone may not cure OSA. As suggested by the 2016 review, other anatomical areas such as the palate, tongue base, and epiglottis may also obstruct the upper airway.
It's important to point out that these results were from individuals who were selected for a tonsillectomy due to enlarged tonsils. The review did not include patients with small, nonhypertrophied or grade 1 tonsils.
In a separate study, researchers suggest that tonsillectomy alone should be a primary therapy for OSA patients with enlarged tonsils.
However, it also pointed out the potential risks associated with tonsillectomy procedures. Uvulopalatopharyngoplasty (UPPP) surgery, which usually includes removal of the tonsils, can be painful and recovery can take several weeks. The procedure can also lead to complications such as swallowing problems and aspiration (entry of material such as food and liquid into the airways).
A tonsillectomy, even without UPPP, comes with its own set of risks. If you have tried to address your OSA symptoms through weight reduction and CPAP therapy and are still struggling with sleep-disordered breathing, you may want to speak with your doctor to see if a tonsillectomy could be the right treatment option for you.