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Surgery For Sleep Apnea

Sleep apnea is a medical term for people who experience breathing problems during their sleep. Considering how important it is to have good sleep hygiene in order to have a productive life, this condition becomes often problematic to many who experience it. People who experience it, often wake up with a jerk as they suffer from attacks of breathlessness during their sleep.

This also results in less amount of oxygen reaching vital organs and many complications arising from this one condition. 

There are two common types of sleep apnea that occurs. One of them is obstructive and the other is central sleep apnea.

1.      Obstructive sleep apnea

It is more common than central and can occur in every age group. However, it is most commonly seen in adults and people who are overweight or obese. Obstructive sleep apnea is due to obstruction of airflow due to narrowing of the passages and can be due to a lot of different reasons. For the ones with structural abnormalities and severe cases of sleep apnea, they are recommended surgery. Resolving this condition becomes critical in these patients, as it can worsen and cause heart problems, dementia, stroke, hypertension as well as diabetes.

2.      Central sleep apnea

It is not related to the muscles of the respiratory tract, instead the problem lies in the brain. The brain fails to send signals to the respiratory centers and hence causes bouts of breathlessness during sleep. Central sleep apnea cannot be treated with surgery, and is best managed with conservative therapy. 

Some of the surgical procedures that exist to help treat obstructive sleep apnea are mentioned in the following text.

Orthognathic Surgery

In simpler words, this surgical procedure is done for correcting the jaw and its features. It is also known as the ‘corrective jaw surgery’. It is a surgery involving a lot of complicated techniques and procedures. A person with abnormal facial features who also has trouble during sleep, is eligible to get this surgery done. This surgery is recommended to those with severe face deformity as it is a pretty costly procedure. It costs about 80,000 to 90,000 US dollars. These charges can vary according to different setups in different countries, but it is still a lot expensive when compared to other minor procedures done to correct sleep apnea.

There are also a list of complications and side effects that come with it. One of the most common of them all, is the chance of acquiring an infection. Patients are therefore given antibiotics prophylactically both before and after the surgery. The time taken for a person to completely heal and recover can take up to 4 to 5 months. However, despite the long list of complications and a prolonged phase of recovery, this surgery has shown great improvements for curing sleep apnea. However, it is only advisable to get this surgical procedure done, if there is severe sleep apnea due to defect in the structure of the jaws. 

Bariatric Surgery For Sleep Apnea

All those surgeries that help in losing weight are commonly grouped as bariatric surgeries. In case you aren’t sure as to what connection does losing weight and sleep apnea hold, well there is surprisingly a lot of common ground. 

A person who is obese has a lot more tissue present at the back of his/her neck which causes problems in breathing, especially when the person is lying down. The success rate of these procedures, helping cure sleep apnea is considerably high. This automatically reflects on helping patients get rid of breathlessness during sleep.

There are a lot of different procedures that work in helping lose weight. Most of them work on decreasing the volume of the stomach, so that the person feels full after consuming just a small amount of food. 

This has been very helpful for obese patients to lose weight and help cure sleep apnea. However, there are some disadvantages that come with it. The person is very likely to become deficient in iron, vitamins and minerals. Moreover, deficiency of calcium in the body leads to hyperparathyroidism and weak bones, making the person prone to fractures. 

The cost of these procedures range considerably from country to country, however the average amount estimated is from 17,000 to 27,000 US dollars, as mentioned by MultiCare Bariatric Program. 

Deviated Nasal Septum Surgery

If a person suffers from a deviated nasal septum (septum that is deviated to one side), then that person experiences a certain amount of blockage in the passage of air. This blockage makes it difficult for the person to breathe. The condition especially worsens while sleeping causing sleep apnea and snoring.

The best way to get rid of this condition, is to get surgery done to correct the septal defect. This surgery is very common and is considered a minor procedure in rectifying cases of sleep apnea.

Some of its side-effects includes; excessive bleeding, complete deformity of the nose and decreased or lost sense of smell. However, these complications occur rarely. 

The cost that it covers is also a lot less than other extensive procedures required to cure sleep apnea, with it ranging not more than 2,000 US dollars. 

Inspire Implant for Hypoglossal Nerve Stimulator

This is another surgical procedure for correcting sleep apnea. This surgery requires the implantation of a device inside the body, in order to stimulate the Hypoglossal nerve. This nerve's stimulation results in the contraction of the muscles of the upper respiratory tract as well as the tongue. This helps in widening of the tract and making the person breathe easily while sleeping. 

This procedure does not prove to benefit anyone with structural abnormalities. People without any underlying structural deformity are hence eligible to get this implant as their air passage is not compromised otherwise. 

However, it is contraindicated for the ones who have medical conditions that require them to get frequent MRIs, as this device is not safe for MRI machines.

This process is done under general anesthesia and comes with complications like; excessive bleeding, Hypoglossal nerve damage, scarring, insomnia and infection. The ones who do get this procedure done, experience 68% reduction in their apneic episodes during sleep. 

This surgery costs around 30,000 to 40,000 US dollars, with another 17,000 dollars required for battery replacement (if needed).

Uvulopalatopharyngoplasty (UPPP)

This surgery either removes, or remodels the tissues present inside the mouth. This surgery is pretty common but its effectiveness in curing sleep apnea has been minimal. This surgery involves the uvula (the finger-like projection hanging from the roof of your mouth) to be removed or plastered to the upper wall, along with removal of either the tonsils and the adenoids. The whole purpose of this procedure is to widen the space at the back of the throat. It may result in widening of the upper throat but also ends up narrowing the nasal passage. Hence, this procedure does not provide any promising results in treating sleep apnea, however, it does help cure snoring. People often experience changes in their voice after this surgery. 

This procedure is however contraindicated in people who are obese. 

The total cost of this procedure stays under 10,000 US dollars and varies greatly from country to country. 

Pillar Procedure

It is also known as insertion of palatal implants in the soft palate. The pillar procedure is another one of the surgeries used, in order to prevent sleep apnea and snoring. The procedure involves the insertion of two rods of polyester to be implanted in the palate. This helps the muscles of the palate to stay rigid and firm, helping in the passage of air as the area widens. 

This procedure is only known to help in mild cases of sleep apnea, it however has a greater effect in the control of snoring. 

It is considered as one of a minor surgical procedure, and its costs range somewhere below 2,000 US dollars. Complications of this procedure are minimal and usually resolve within a week or two. However, in cases of the rods protruding out of the soft palate, it either requires replacement or removal. 

Sleep Apnea Jaw Surgery 

This surgery is rather complicated and is only reserved for people with severe cases of sleep apnea. The procedure of this surgery involves the widening of the airway by bringing either the upper or the lower jaw forward. This requires several cuts to be made in the jawbone in order to make it move forward 10 to 15 mm. The bones are locked in its place by the insertion of titanium plates.

This surgery has shown impressive results in curing sleep apnea, about 90% of cases get rid of it through this procedure. However, due to its complexity and complications it is not preferred and done that often. 

The process of recovery after this procedure is long and slow. The first few weeks, the jaws are completely sealed and wired shut in order to make them stay at their place. 

There are a number of complications that can arise after this procedure such as; nerve damage, temporomandibular joint problems, vascular disease, bone necrosis as well as periodontal disease. 

With a surgery that requires such precise and complicated steps, it is pretty expensive. It ranges from 40,000 to 70,000 US dollars. People with structural deformity because of which they have trouble breathing and even more so during their sleep, should opt for this surgery- otherwise go for less invasive procedures.

Weight Loss Surgeries for Sleep Apnea

People who are obese, without any structural abnormality experience severe cases of sleep apnea. Their airways get obstructed due to many tissues placing pressure from the back of the neck. This can only be resolved with the reduction of weight. 

Hence, there are a number of procedures that help in losing weight so that the problem of sleep apnea can be resolved. Some of the common weight loss surgeries are explained below;

  • Gastric bypass; a smaller pouch acting like the stomach is created so that satiety is reached earlier with much less hunger pangs. This procedure can help reduce weight by upto 80 percent.
  • Sleeve gastrectomy; this procedure also involves taking most part of the stomach out, with just a small portion left, which resembles a sleeve or a banana. It can help in weight loss for more than 50%. However, this procedure cannot be reversed and might lead to deficiency of vitamins.
  • Adjustable gastric band; a band is placed at the opening of the stomach in order to give a feeling of fullness and therefore help in the consumption of less food. This procedure is effective yet it has a lot of complications due to a foreign material being placed inside of the body.
  • Biliopancreatic diversion with duodenal switch; in this procedure, the stomach gets connected directly to the last part of the small intestine. This makes the pancreatic enzymes and bile to have minimal chance to breakdown and absorb fats and proteins. This procedure is most effective in losing weight as compared to the rest, however, it comes with a lot more complications and with a higher mortality rate. 

Sleep Apnea Surgery Cost

The price for surgery depends on the complexity and procedure preformed. Jaw surgery may cost up to $100,000. Less invasive surgery such as nasal or throat surgery price can run up to $10,000. Many procedure may be covered by medical insurance.  

Conclusion

People who suffer from breathing issues during sleep should resort to first conservative management by taking medicines and nasal decongestants. However, if medical treatment does not work for them, they should get their condition treated through surgery. It is extremely important to treat sleep apnea, as otherwise it poses a great threat to the overall well being of the body. 

There are a number of surgical procedures that help in the management of this disease, out of which most of them focus on correcting some underlying structural defects because of which this condition appears. For instance, people with enlarged adenoids or tonsils, should get either an adenoidectomy or a tonsillectomy to make space for air to pass easily down their respiratory passage. Other than that, people with significant face defects should go for jaw correctors surgery, so that their bone structure can be restored to normal and that they can breathe easily. There are