Sleep Apnea Surgery: Long-Term Care

Sleep apnea surgery can improve or alleviate obstructive sleep apnea in many patients. Almost all sleep surgery research studies have evaluated results at three to six months following surgery, and this is the typical time that a patient would have a postoperative sleep study to evaluate the results of surgery.

Most patients show improvements in sleep apnea at this time, with the improvements greater in some patients than others. However, the goal of any surgery is to obtain long-term results, so it is important to consider how to maintain the benefits of surgery over time.

Benefits of Surgery

There are no studies that examine the best way to improve or at least maintain the benefits of surgery. That being said, clinical experience with patients identifies several factors that can improve or worsen sleep apnea.

Changes in Body Weight

Improving obstructive sleep apnea can improve sleep quality and energy level, allowing patients to increase physical activity. Some patients also experience a decrease in calorie intake, similar to the changes seen in studies that restrict sleep and then allow an increase back to normal sleep time.

Both of these can result in weight loss, which would be a major factor in improving results of surgery. The opposite is also often true, as weight gain would decrease the benefits of surgery.

Changes in Body Position

Positional sleep apnea is common and generally described as occurring when sleep apnea is at least twice as bad when someone is sleeping on their back, compared to not sleeping on their back. In some cases, surgery can lead to a situation in which changes in body position are even more helpful after surgery than they were before surgery. 

Aging

This has not been studied well for sleep apnea surgery or any treatment, but we do know that obstructive sleep apnea is more common as people age, at least up to 60 years of age, when the prevalence stabilizes.

Weight gain that often occurs with aging is an important part of this increase in sleep apnea, but natural relaxation changes in the body’s soft tissues (often called tissue laxity) likely play a role.

Possible Future Surgeries

Sleep apnea surgery does not routinely need to be repeated. However, if surgery does not achieve results that are good enough, or if the results decrease over time, additional treatment may be needed. It is important to consider the full range of treatments, including positive airway pressure therapy (PAP), additional surgery, or oral appliance mouthpieces.

Some patients may find that surgery helps them tolerate PAP more easily. Surgery may open the space for breathing enough so that their PAP pressures are lower or otherwise make PAP more comfortable. Because of this, a repeat PAP trial after surgery can be successful if surgery did not alleviate the obstructive sleep apnea.

If the repeat PAP trial is not successful, the next step is to determine what is causing the persistent obstructive sleep apnea to identify other treatments (typically surgery and/or oral appliance mouthpieces) that may be appropriate. 

Drug-induced sleep endoscopy is an evaluation procedure that involves sedating patients in a controlled setting (generally the operating room or an endoscopy suite). Drug-induced sleep endoscopy is designed to reproduce the blockage of breathing in the throat that occurs in patients with obstructive sleep apnea, similar to natural sleep.

The choice of treatment options may be based on the cause(s) of this blockage of breathing. Drug-induced sleep endoscopy can be performed before any surgery but may be especially helpful for patients who have obstructive sleep apnea after previous surgery.  

Lifestyle Adjustments

Lifestyle changes can be the key to weight loss—or at least avoiding weight gain. These include increasing physical activity and decreasing calorie intake, as mentioned above.

A Word From Verywell

Long-term results are important in obstructive sleep apnea, but studies on long-term outcomes are not clear for any treatment (not just for surgery). Sleep apnea surgery decisions are based on the research that has been done, evaluating results at three to six months following surgery

Beyond this point in time, our limited understanding suggests that the benefits may be affected by changes in body weight, changes in body position, and the natural aging process.