Surgery for management of OSA has advantages and also challenges.  For most adult patients, many of the surgeries for OSA is second line to medical therapy.   Outside of minor procedures and nasal surgeries, CPAP should be tried before considering more significant OSA surgery. 

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The main advantage of OSA surgery is that any improvement that is obtained with surgery does not depend upon constant use of a device such as CPAP or oral appliances.

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Pros

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• Improvement not based on usage of a device.

• Adherence is not an issue.

• No equipment issues.

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Cons

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• Surgical risk.

• Risk of side effects. 

• Some more invasive procedures can have significant recovery periods. 

• Further treatment maybe needed.

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Surgical Treatments

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• Nasal Surgery:  Nasal congestion is one of the leading causes of CPAP or Oral Appliance intolerance.  Corrective surgery can help. 

• Minimally invasive techniques such as Pillar Implant and Radiofrequency treatment:  Generally best limited to milder cases of OSA. 

• Modification or removal of tissue: Uvulopalatopharyngoplasty (UPPP), partial removal of tongue base tissue, tonsillectomy or adenoidectomy if appropriate.   Hyoid suspension, genioglossus advancement.

• Modification of Jaw:  Maxillomandibular Advancement

• Upper airway stimulation:  Inspire Upper Airway Stimulator implant. 

• Tracheostomy (surgical opening in the neck).  Highly effective and essentially curative but usually an option of last resort.  Typically reserved for very severe situations.

• Bariatric Surgery:  Weight loss surgery maybe appropriate. 

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