Sleep apnea surgery


Sleep surgery is a surgery performed to treat sleep disordered breathing, a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. 



These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.



Obstructive sleep apnea is defined as either cessation of breathing for 10 seconds, or a decrease in normal breathing, hypopnea, with an associated desaturation in oxygen and arousal during sleep that lasts at least 10 seconds. 



Healthy adults have up to 4.9 cessation of breathing events per hour. 



In obstructive sleep apnea, affected individuals are categorized by how many apneas or hypopneas (apnea-hypopnea index or AHI) or events they have per hour.



Normal: <5 events per hour



Mild: 5 to <15 events per hour



Moderate: 15 to 30 events per hour



Severe: >30 events per hour



Most patients with OSA have multiple points of obstruction in their airway and require multilevel sleep surgery in order to maximize the efficacy of treatment. 



Multilevel sleep surgery achieves a 60.3% apnea hypopnea index (AHI) reduction: compares well against the AHI reduction for best case CPAP patients where an overall AHI reduction of 66% was achieved.



Single level surgical intervention in sleep apnea, has a lesser degree of AHI reduction, showing a 31% benefit when compared against those using CPAP as therapy.



Children with obstructive sleep apnea usually have enlarged tonsils and adenoid tissue, and surgery is over 80% successful by simply performing an adenoidectomy and tonsillectomy. 



Children may have laryngomalacia, and may benefit from a supraglottoplasty to help prevent that tissue from collapsing into the airway.



Adults with large tonsils may be candidates for having their tonsils and/or adenoids removed.



Uvulopalatopharyngoplasty is the most common procedure performed for sleep apnea.



 The uvulopalatopharyngoplasty (UPPP). involves removal of the tonsils if still present, and a subsequent palatal procedure. 



The uvula is either trimmed, or sutured to the soft palate.



Hyoid suspension 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.



Hyoid suspension improves airway stability in the airway behind and below the base of tongue.



Genioglossus advancement is a procedure that pulls the base of the tongue forward to increase airway size due to deformity or a sleep breathing disorder. 



Genioglossus advancement is frequently performed with either uvulopalatopharyngoplasty or maxillomandibular advancement surgeries.



Maxillomandibular advancement or orthognathic is a procedure that moves the maxilla and the mandible forward is 


used for patients with obstructive sleep apnea. 



Maxillomandibular advancement surgery  is often performed simultaneously with genioglossus advancement, pulling  the tongue forward to decrease the amount of tongue blockage during sleep. 



Maxillomandibular advancement surgery   is one of the most effective surgical treatments for sleep apnea,  and is often used after other forms of treatment have failed.



Tracheostomy bypasses the upper airway, and was a procedure previously performed for obstructive sleep apnea.



Continuous positive airway pressure (CPAP), which replaced tracheostomy as the gold standard treatment for obstructive sleep apnea. 



CPAP machines are specially designed to deliver a constant flow or pressure. 



Continuous positive airway pressure  is the most effective treatment for obstructive sleep apnea, in which the pressure from CPAP prevents the airway from collapsing or becoming blocked.



Many models of CPAP face masks exist.



Mandibular advancement device or mandibular advancement splint may be used to treat for mild or moderate OSA. 



There is evidence for supporting the use of oral devices in the treatment of OSA.



High levels of nasal resistance negatively affects mandibular advancement splint efficacy.



Tongue retaining devices are devices keep the tongue in a forward position, and have been used for snoring and obstructive sleep apnea.



Tongue retaining devices hold the tongue in place by: suction, a fixed bar, or a custom dental impression. 



Hybrid devices exist that combine mandibular advancement with the tongue restraint.






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