Which surgery for sleep apnoea has the best long term result?

Surgery for Adult Obstructive Sleep Apnoea has been the topic of much debate. In recent years, surgeons have modified techniques to improve airway calibre and reduce complications by being reconstructive rather than ablative. One technique that has gained momentum and was developed in Australia is the “modified (Robinson) uvulopalatopharyngoplasty and coblation tongue channeling”. This procedure was published in the Journal of Clinical Sleep Medicine in February 2013, and is easily reproducible and has minimal side effects. It is believed that this multi-level operation, when applied to appropriately selected patients, will have greater longevity and broader acceptance than older, ‘traditional’ UPPP variants and earlier radiofrequency tongue interventions. The most appropriate consideration is what is the correct operation for the patient, as everyone has different factors in the upper airway contributing to sleep apnea, so needs an individualised surgical treatment plan. 
 

This question is an excellent one for highlighting the problems with Dr Google. We see many people who have read about this or that and have decided they want it done. Our approach is not too dismiss these requests but to redirect the conversation to what part if the nose or throat is involved in snoring or sleep apnoea and recommend the best treatment, which is usually not surgery, though it plays a role. A modern approach to surgery is definitely more appropriate than previous efforts. 

Wat if u sleep longer than normal hours, like up to 10hours per day, is there any treatment that you may recommend? My appetite is good, and would recently giving up ciggerrettes(2weeks,cold turkey aft 30yrs or so) maybe conttibuting to my tirrdness too?, all the best, Anthony.

The amount of sleep each person needs us variable, so 10 hours is not necessarily a problem. It is more the quality of that sleep that is most relevant. You won't regret quitting smoking either. There are a host of reasons for feeling tired, and your GP is the best professional to start with in terms of looking into this. 

Like many medical problems, the question is “does it need treatment?” The answer depends on whether it is mild, moderate or severe. The parallel question is whether someone with arthritis of the knee will benefit from a knee replacement - yes if the arthritis is severe and affecting their quality of life. Sleep apnoea usually needs treatment for one of two reasons:

The sleep apnoea is moderate or severe - because of the associated risks of sleep apnoea (high blood pressure etc.)

Or the symptoms are severe enough to warrant treatment - to improve quality of life (this may include mild OSA).

Therefore it is important to know whether the sleep apnoea is mild, moderate or severe and this requires sleep studies (polysomnography).The usual initial treatment offered is CPAP (continuous positive airways pressure) so I'm assuming this treatment has not worked out for your son. There is quite a high failure rate of CPAP for a variety of reasons eg. not well tolerated, masks not fitting. Under these circumstances, it may be worth considering an assessment for surgery. I've counted 17 different types of surgery for OSA although less than 10 are mainstream. So this is a complex area. The point to make is that there may well be alternatives to CPAP. Those with moderate or severe OSA should really not “give up” at the stage of perhaps failing CPAP therapy. It's well worth exploring surgical options with a specialist OSA Surgeon.It's quite common for GP's to see people who have tried CPAP (for moderate or severe OSA) and havn't gone any further. This is a problem because the untreated moderate or severe sleep apnoea has long term issues for health - quality of life, mental performance, driving risks, high blood pressure and cardiovascular risks. So there are now lots of surgical options and evidence is building that there are improved outcomes for selected surgery.