Sleep Apnea Surgery: Sham or Science?

As a surgeon, it’s difficult for me to say that most surgical procedures that are performed for sleep apnea don’t work. But like everything else in life, it’s never black or white—there are always various shades of gray.


Many people (and surgeons) think of the upper airway as a simple tube that channels air into the lungs. What’s not appreciated enough is that this passageway from the tip of the nose to the vocal folds is highly dynamic, constantly changing, with multiple levels of partial to total obstruction. There are major areas of potential obstruction (nose, soft palate and tongue), but there are many other factors that can cause inflammation, swelling, or narrowing, in addition to these 3 major areas. These other factors can include weather changes, your emotions, what you just ate, sleep position, drugs and medications, and your weight.


But even if you consider the three major areas only, even then it’s not that well understood. Imagine a simple, long semi-collapsible tube connecting your nose to you windpipe. If there’s one area of obstruction, then opening up this area will help should help in most cases (for example, large tonsils). But let’s say that in addition to the tonsils, you also have nasal congestion due to a deviated nasal septum. Then by undergoing only a tonsillectomy, you may feel better initially, but over time, vacuum forces created in the throat by having a stuffy nose will aggravate soft palate and tongue collapse, leading to sleep apnea later in life. If you start with obstruction in the tongue area, soft palate and the nose, then opening up the soft palate obstruction only may work sometimes, but not all the time.


This is the reason for the 40% success rate of the uvulopalatopharyngoplasty procedure (UPPP). You can argue what the meaning of surgical success, but that’s for another discussion. So this leads to one of the most common questions that I get asked: Does the UPPP procedure work for sleep apnea? The answer is yes, but only in people who have obstruction purely in the soft palate area, especially if you have very large tonsils. This situation occurs only in about 40% of the time in adults. 


In young children, undergoing tonsillectomy only without soft palate surgery is found to "cure" sleep apnea in about 2/3 of patients. This makes sense, since tonsils tend to be relatively bigger in children. But what’s the reason for residual sleep apnea in the other 1/3 of children? The answer is for the same reasons as in adults: smaller jaws that lead to tongue collapse and nasal congestion. Even in the children who are considered initially "successful," a certain proportion will go on to slowly re-develop obstructive sleep apnea, due to their smaller jaw anatomy and predisposition for inflammation in the upper airways. The tongue becomes more of an issue later in adulthood as the voice box develops and descends down in the throat. 


So does sleep apnea surgery work? Like everything else in life, it depends. 


If you want more detailed information on the truth about sleep apnea surgery, sign up for my free report on the box to the right.


Did you ever undergo surgery for sleep apnea? Was it addressing one level or multiple levels? Please enter your response in the comments box below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

3 thoughts on “Sleep Apnea Surgery: Sham or Science?

  1. When I saw my ENT following diagnosis of UARS, he described me as a “tough” patient to treat, as he found several points along my airway that by themselves are not significant, but together add up to the bigger problem.

    He described several procedures he could do (some of them sounded extreme) and then stated that he could not guarantee it would help.

  2. Yes recently had it on palate . Hard to swallow now . Like lump in throat . Use mandibular device still no luck . Getting sinus infections off and on even and wonder if I have gerd. At times my tongue hurts with sores . Mouth lining hurts who knows . I dont sleep when I should and I’m a mess

  3. I did have surgery for sleep apnea on palate only but was told afterwards my tongue to is some of the problem and would need more work due to this somewhere on back of tongue and it wouldn’t be as painful as the palate surgery . Going to put a call in to them . I feel like I have a lump in my throat. I do have a sleep dr who put me on cpap which I can’t keep on. Another put me on a mandibular device which most of the time I can tolerate but other times gets to me too because it’s so tight. Wake up with headaches and feeling lack of oxygen. But there are times I feel ok awaking . Read about reflux and sinus congestion articles . Could be some of the problem . Back of throat hurts and tongue gets sore and read . I do have fibromyalgia and lupus so not sure . There so much involved . I have overlapping conditions . It’s crazy . I’m 57 so been in menopause too and mental illness in family . Thyroid problems . I could scream . I really appreciate your reply and hope with time all this will get resolved . Thanks