Consultant ENT Surgeon in Andheri, Goregaon, Malad.
Obstructive sleep apnea (OSA) is caused by repeated collapse of the upper airway during sleep. When conservative measures (CPAP, oral appliances, weight loss) fail or are not tolerated, targeted surgery of the palate, tongue base, and epiglottis can reduce obstruction, improve breathing, and decrease daytime sleepiness. Surgery is selected after a thorough evaluation including sleep study (polysomnography) and airway examination (endoscopy or drug-induced sleep endoscopy).
Loud, habitual snoringWitnessed apneas or gasping/choking during sleepExcessive daytime sleepiness, poor concentrationMorning headaches, dry mouth on wakingFragmented sleep and partner sleep disturbanceOSA is multifactorial. Common anatomical contributors include floppy or enlarged soft palate/uvula that narrows the oropharynx, an enlarged or posteriorly positioned tongue base that falls back during sleep, and epiglottic collapse (retroversion) which blocks the laryngeal inlet. Obesity, nasal obstruction, large tonsils, craniofacial structure, and reduced muscle tone during sleep also increase collapse risk.
Surgery is tailored to the site(s) of obstruction and may be performed singly or in combination.
Palate surgery: Procedures such as uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty, or minimally invasive palatal stiffening remove or reshape excess tissue and widen the oropharynx to reduce collapsibility.
Tongue base surgery: Options include tongue reduction (radiofrequency, midline glossectomy), transoral robotic surgery (TORS) to remove tissue, or hyoid suspension and genioglossus advancement to pull the tongue forward and enlarge the hypopharynx.
Epiglottis surgery: When the epiglottis retroverts and obstructs airflow, epiglottopexy (fixing the epiglottis anteriorly) or partial epiglottidectomy can be performed endoscopically to prevent collapse.
Multilevel surgery: Combining palate, tongue base, and epiglottis procedures often yields better outcomes in multilevel collapse.
Surgery can reduce apneas and symptoms but may not fully replace CPAP for all patients. Risks include pain, bleeding, infection, dysphagia, voice change, and need for revision. Recovery varies by procedure; careful preoperative assessment and postoperative follow-up including repeat sleep testing are essential.
Maintain healthy weight and regular exercise to reduce fatty tissue around the airway.Avoid alcohol and sedatives before bedtime which worsen airway collapse.Use positional therapy if apneas are worse on the back (avoid supine sleep).Treat nasal obstruction (allergy control, septoplasty) to improve nasal breathing.Adhere to CPAP or oral appliance therapy when recommended; consider surgery only after specialist evaluation.