Should I have surgery to treat obstructive sleep apnea?

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

If you do not treat obstructive sleep apnea (OSA), it can cause several problems. If you have sleep apnea, you may be at risk for excessive daytime sleepiness and complications such as high blood pressure, high blood pressure in the lungs (pulmonary hypertension), depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

Consider the following when making your decision:

• You should try continuous positive airway pressure therapy (CPAP) before trying any type of surgery. Most experts do not suggest surgery for sleep apnea unless you have tried CPAP first.
• You may consider surgery as initial treatment if a blockage is clearly reversible, such as from having overly large tonsils, or if you are at high risk for developing complications from sleep apnea.
• You might still need CPAP after uvulopalatopharyngoplasty (UPPP) surgery. There is no good evidence on how well this surgery works for sleep apnea.¹ Limited research shows that about 40% to 60% of people who have UPPP see an improvement in their symptoms.²
• If you are extremely overweight (severely obese), you might think about bariatric surgery to help you lose weight. Losing weight may improve sleep apnea symptoms or end them completely.³
• Tracheostomy almost always cures sleep apnea that is caused by blockage of the upper airway. But you are at risk for many complications, and you may worry about how you will look after surgery. Other treatments are nearly as effective as tracheostomy in most people.

What is obstructive sleep apnea?

Sleep apnea occurs when you regularly stop breathing for 10 seconds or longer during sleep. It can be mild, moderate, or severe, depending on the number of times an hour that you stop breathing (apnea) or that air flow to your lungs is reduced (hypopnea). Apnea episodes may occur from 5 to 50 times an hour.

What causes obstructive sleep apnea?

A blockage or narrowing of the airways in your nose, mouth, or throat generally causes obstructive sleep apnea (OSA). This usually occurs when the throat muscles and tongue relax during sleep and partially or completely block the airway.

Sleep apnea can also occur if you have bone deformities or enlarged tissues in the nose, mouth, or throat. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.

Other factors that make sleep apnea more likely include using certain medicines or alcohol before bed, sleeping on your back, and being obese.

If you need more information, see the topic Sleep Apnea.

You have the following choices:

• Use continuous positive airway pressure therapy (CPAP). CPAP uses a machine that helps you breathe more easily during sleep. The machine increases air pressure in your throat so that your airway does not collapse when you breathe in. Your using CPAP may also help your bed partner sleep better. See a picture of CPAP.
• Have uvulopalatopharyngoplasty (UPPP) surgery. UPPP removes excess tissue in the throat to make the airway wider. Widening the airway sometimes can allow air to move more easily through the throat. In adults, this is the most common surgery to treat obstructive sleep apnea.
• Have bariatric surgery if you are extremely overweight. During bariatric surgery, the doctor reduces the size of your stomach to help you lose weight. Losing weight may improve sleep apnea symptoms or end them completely.³
• Have tracheostomy surgery. In this procedure, the surgeon creates a permanent opening in your neck to your windpipe (trachea). He or she then puts a tube in the opening to help you breathe at night. Tracheostomy almost always cures sleep apnea that is caused by blockage of the upper airway.

The decision about whether to have surgery for obstructive sleep apnea takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for sleep apnea. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for obstructive sleep apnea.

Check the box below that represents your overall impression about your decision.

Return to the topic Sleep Apnea.

Citations

1. Sundaram S, et al. (2006). Surgery for the treatment of obstructive sleep apnoea. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

2. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.

3. Buchwald H, et al. (2004). Bariatric surgery: A systematic review and meta-analysis. Journal of the American Medical Association, 292(14): 1724–1737.

4. Giles TL, et al. (2006). Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.

5. Hensley M, Ray C (2006). Sleep apnea. Clinical Evidence (15): 1–18.

6. Pepperell JC, et al. (2002). Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised study. Lancet, 359(9302): 204–210.

7. Becker HF, et al. (2003). Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation, 107(1): 68–73.

8. Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360(9328): 237–245.