Sleep Apnea Surgery: What to Expect on the Day of Surgery

Sleep apnea surgery can be any of more than a dozen different procedures aimed at correcting anatomy than can contribute to sleep apnea. It is often performed as outpatient surgery but may require general anesthesia. See what to expect during sleep apnea surgery, including the need for postoperative assessment.

Before the Surgery

It is important for a formal consultation with a board-certified surgeon to occur prior to sleep apnea surgery. On the day of surgery, further testing is not generally required.

In the unlikely event that a blood transfusion should become necessary, due to significant blood loss during the procedure, a type and crossmatch test would be done to determine the patient’s blood type and compatibility.

Upon arrival at the surgery center, the patient will change into a hospital gown and vital signs may be checked. There may be a brief conversation with both the surgeon and the anesthesiologist in the pre-operative waiting area.

As the anesthesiologist is likely meeting the patient for the first time, there may be some questions about prior surgical history and a brief look in the mouth to assess the airway.

During the Surgery/Procedure

Sleep apnea surgery refers to multiple potential procedures that are used to correct anatomy that may obstruct the airway and predispose to both snoring and sleep apnea.

Some of these procedures, such as turbinate reduction, may be performed in a clinic’s procedure room with a local anesthetic. Others require general anesthesia and are performed in an operating room. For the purposes of this discussion, these more intensive procedures will be described here.

Procedures

It is hard to summarize diverse surgical techniques that may be done on the nose, throat, soft palate, tongue, or jaw. Consider some of these possible sleep apnea surgery procedures:

• Turbinectomy: Removal of the nasal turbinates
• Nasal septoplasty: Repositioning and straightening of the nasal septum
• Adenoidectomy: Removal of the adenoids
• Tonsillectomy: Removal of the tonsils
• Uvulopalatopharyngoplasty (UPPP) or palatopharyngoplasty: Removal or remodeling of the uvula, soft palate, and tissues lining the pharynx
• Expansion sphincter pharyngoplasty: Repositioning the soft palate by anchoring the palatopharyngeus muscle forward
• Lateral pharyngoplasty: Removal or remodeling of the soft palate and tissues at the sides of the pharynx
• Uvulopalatal flap: Used to correct a thin soft palate by folding the mucosa
• Palatal advancement pharyngoplasty: Removal of some of the hard palate to pull the soft palate forward
• Z-palatoplasty: Dividing the soft palate and pulling each half forward and laterally to correct prior scarring on the sides of the throat
• Relocation pharyngoplasty: Sewing the muscles on the sides of the throat
• Tongue radiofrequency: Reduction of the tissues at the base of the tongue
• Genioglossus advancement: Movement of the tongue’s suspension muscle forward
• Hyoid suspension: Displacement of the hyoid bone forward to move the tongue forward
• Maxillomandibular advancement: Movement of the upper and lower jaws forward
• Inspire hypoglossal nerve stimulator placement: A pacemaker for the tongue to improve breathing during sleep
• Tracheostomy: Placement of a hole within the throat to aid breathing

To fully understand what procedure is (or procedures are) planned, it is necessary to have a conversation with the surgeon prior to the day of the surgery. Confirming the specific techniques that will be done is paramount to the consent process.

It is common for several procedures to be done at the same time (such as removal of both the adenoids and tonsils). In some cases, the surgery may be done in phases separated by months, to allow for healing and assessment of the response to the initial procedure before additional surgery may be done to resolve residual symptoms.

Steps in Surgery

What actually happens when sleep apnea surgery is performed in an operating room? With the more than 17 procedures listed above, it is difficult to summarize across them all. It is possible to provide some general steps integral to almost all types of surgery while leaving specifics out. Consider these steps:

• Monitoring equipment may be set up, such as an oximeter to assess blood oxygen levels and pulse, a blood pressure cuff, or electrocardiogram (ECG or EKG) patches to follow the heart rhythm during the surgery.
• The patient will have an intravenous (IV) line placed by a nurse or technician for the administration of any required medications and fluids, including initial sedatives.
• The anesthesiologist will place a plastic mask over the nose and mouth to administer the anesthetic gas. After a few deep breaths, the patient will usually fall asleep and will next remember waking in the post-operative recovery room after the surgery has been completed.
• While unconscious, the patient will next be intubated, with a breathing tube placed in the throat and connected to a ventilator.
• The patient will be transferred to the operating table, often with the help of multiple operating room staff members.
• The surgeon, nurses, and operating room assistants will have scrubbed in, washing their hands and dressing themselves in sterile gowns, gloves, masks, and eye shields.
• Sterile drapes will be placed over the patient and operating tools and lights will be moved into place.
• The area of the body subject to the procedure will be better visualized, often with the assistance of retractor instruments. Cutting tools such as scalpels will be used to move or remove tissues that are obstructing the airway. Suctioning will draw away blood or other secretions.
• Stitches, splints, or even titanium plates or screws (in the case of jaw surgery) may be used to stabilize the tissues in their new positions. This will promote healing that may further open the airway as time passes and swelling subsides.
• At the conclusion of the procedure, the sterile drapes will be taken down and the breathing tube will be removed. The patient will be transferred to a gurney and moved to the recovery room to wake from the sedation.

How Long Does Surgery Take?

Sleep apnea surgery may last a variable amount of time, depending on the procedure. As a general rule, most will last from 45 minutes to several hours. Turbinate reduction or tonsillectomy may be relatively quick. Jaw surgery is a more intensive and prolonged procedure.

Pain Management

With general anesthesia, a patient will not be conscious of pain during the surgery. In recovery, pain management may vary depending on the procedure that was performed.

After the Surgery/Procedure

Outpatient surgery centers at which most sleep apnea surgery is performed will send most patients home after waking in the post-op recovery room. This is the most likely outcome.

In higher-risk patients, or in those who have undergone a more extensive or complicated surgery, this may require a hospitalization that could be overnight to several days (and rarely longer) in duration.

The discharge will include instructions on post-operative care, when to resume normal activities such as eating or working, and what to do in the case of emergencies such as changes in breathing, uncontrolled bleeding, or signs of infection.

There may be supplies issued to deal with a dressing or packing change, especially with nasal surgery. This may also be addressed at follow-up in the clinic shortly after the procedure, such as nasal splint removal that usually occurs in a clinic one week after septum surgery.

It is advised that patients remain in the company of a responsible adult during the first 24 hours after surgery. Further recovery, including the ongoing use of over-the-counter and prescription pain medications, the timeline for resumption of normal activities, and other considerations will depend on the nature of the sleep apnea surgery.

A Word From Verywell

Sleep apnea surgery includes a variety of procedures, many of which are performed under general anesthesia in an operating room. It is important that you ask about expectations prior to the procedure.

As part of this, ensure you understand what the recovery course will look like. If pain is expected before it occurs, it can be reduced prophylactically and be more bearable.

Finally, discuss when it might be appropriate to reassess the condition with post-operative testing to objectively measure the success of the surgery that was performed. This is necessary to ensure further treatment of sleep apnea is not necessary.