Editing Sleep apnea (section)

===Surgery===
[[File:Cautérisation des parties molles - apnée du sommeil.svg|thumb|Illustration of surgery on the mouth and throat]]

Several surgical procedures ([[sleep surgery]]) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances.<ref name="Spi20152"/> Surgical treatment for obstructive sleep apnea needs to be individualized to address all anatomical areas of obstruction.<ref name="Chang-2023" />

====Nasal obstruction====
Often, correction of the nasal passages needs to be performed in addition to correction of the [[oropharynx]] passage. [[Septoplasty]] and [[Nasal concha|turbinate]] surgery may improve the nasal airway,<ref>{{cite journal |last1=Sundaram |first1=Supriya |last2=Lim |first2=Jerome |last3=Lasserson |first3=Toby J |last4=Lasserson |first4=TJ |title=Surgery for obstructive sleep apnoea in adults |journal=Cochrane Database of Systematic Reviews |date=19 October 2005 |issue=4 |pages=CD001004 |doi=10.1002/14651858.CD001004.pub2 |pmid=16235277 }}</ref> but has been found to be ineffective at reducing respiratory arousals during sleep.<ref>{{cite journal |last1=Li |first1=Hsueh-Yu |last2=Wang |first2=Pa-Chun |last3=Chen |first3=Yu-Pin |last4=Lee |first4=Li-Ang |last5=Fang |first5=Tuan-Jen |last6=Lin |first6=Hsin-Ching |title=Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea |journal=American Journal of Rhinology & Allergy |date=January 2011 |volume=25 |issue=1 |pages=45–49 |doi=10.2500/ajra.2011.25.3558 |pmid=21711978 |s2cid=35117004 }}</ref>

====Pharyngeal obstruction====
[[Tonsillectomy]] and [[uvulopalatopharyngoplasty]] (UPPP or UP3) are available to address pharyngeal obstruction.<ref name="Chang-2023" />

[[File:UPPP. 4 figures..png|thumb|upright=1.5|Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.]]

The "Pillar" device is a treatment for snoring and obstructive sleep apnea; it is thin, narrow strips of [[polyester]]. Three strips are inserted into the roof of the mouth (the [[soft palate]]) using a modified syringe and local anesthetic, in order to stiffen the soft palate. This procedure addresses one of the most common causes of snoring and sleep apnea&nbsp;— vibration or collapse of the soft palate. It was approved by the FDA for snoring in 2002 and for obstructive sleep apnea in 2004. A 2013 meta-analysis found that "the Pillar implant has a moderate effect on snoring and mild-to-moderate obstructive sleep apnea" and that more studies with high level of evidence were needed to arrive at a definite conclusion; it also found that the polyester strips work their way out of the soft palate in about 10% of the people in whom they are implanted.<ref name=pillar>{{cite journal | vauthors = Choi JH, Kim SN, Cho JH | title = Efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis | journal = The Laryngoscope | volume = 123 | issue = 1 | pages = 269–76 | date = January 2013 | pmid = 22865236 | doi = 10.1002/lary.23470 | s2cid = 25875843 }}</ref>

====Hypopharyngeal or base of tongue obstruction====
Base-of-tongue advancement by means of advancing the [[Mental spine|genial tubercle]] of the [[mandible]], tongue suspension, or [[hyoid suspension]] (aka hyoid myotomy and suspension or hyoid advancement) may help with the lower pharynx.<ref name="Chang-2023" />

Other surgery options may attempt to shrink or stiffen excess tissue in the mouth or throat, procedures done at either a doctor's office or a hospital. Small shots or other treatments, sometimes in a series, are used for shrinkage, while the insertion of a small piece of stiff plastic is used in the case of surgery whose goal is to stiffen tissues.<ref name=SleepApneaTreatments/>

====Multi-level surgery====
[[Maxillomandibular advancement]] is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space.<ref>{{cite journal | vauthors = Prinsell JR | title = Maxillomandibular advancement surgery for obstructive sleep apnea syndrome | journal = Journal of the American Dental Association | volume = 133 | issue = 11 | pages = 1489–97; quiz 1539–40 | date = November 2002 | pmid = 12462692 | doi = 10.14219/jada.archive.2002.0079 }}</ref> However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant [[Craniofacial abnormality|craniofacial abnormalities]] which hinder device use.<ref name="auspre01">{{cite journal |author=MacKay, Stuart |title=Treatments for snoring in adults |journal=Australian Prescriber |volume=34 |issue=34 |pages=77–79 |date=June 2011 |doi=10.18773/austprescr.2011.048 |doi-broken-date=7 November 2024 |doi-access= }}</ref>

====Potential complications====
Several inpatient and outpatient procedures use sedation. Many drugs and agents used during surgery to relieve pain and to depress consciousness remain in the body at low amounts for hours or even days afterwards. In an individual with either central, obstructive or mixed sleep apnea, these low doses may be enough to cause life-threatening irregularities in breathing or collapses in a patient's airways.<ref>{{cite book |first1=T. Scott |last1=Johnson |first2=William A. |last2=Broughton |first3=Jerry |last3=Halberstadt |title=Sleep Apnea&nbsp;– The Phantom of the Night: Overcome Sleep Apnea Syndrome and Win Your Hidden Struggle to Breathe, Sleep, and Live |publisher=New Technology Publishing |year=2003 |isbn=978-1-882431-05-2 |url-access=registration |url=https://archive.org/details/sleepapneaphanto0000john }}{{Page needed|date=September 2010}}</ref> Use of [[Analgesic|analgesics]] and sedatives in these patients postoperatively should therefore be minimized or avoided.<ref name="Chang-2023" />

Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as [[tonsillectomy]] and [[adenoidectomy]] or tongue reduction, swelling may negate some of the effects in the immediate postoperative period. Once the swelling resolves and the palate becomes tightened by postoperative scarring, however, the full benefit of the surgery may be noticed.<ref name="Chang-2023" />

A person with sleep apnea undergoing any medical treatment must make sure their doctor and [[Nurse anesthetist|anesthetist]] are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.<ref>{{cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |title=What is Sleep Apnea? |year=2012 |website=National Heart, Lung, and Blood Institute |publisher=National Institutes of Health |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20110828030048/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |archive-date=28 August 2011}}</ref>