Sleep Apnea Surgery Options
A comprehensive guide to surgical treatments for obstructive sleep apnea when CPAP isn't working
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Should You Consider Surgery for Sleep Apnea?
Surgery is typically considered after CPAP failure or intolerance. Success rates vary widely (30-90%) depending on procedure type and patient anatomy. Modern options like Inspire and Genio offer 70-80% success with minimal invasiveness compared to traditional surgeries.
Modern vs Traditional Sleep Apnea Surgery
Sleep apnea surgery has evolved dramatically in the past decade. Traditional surgeries (UPPP, MMA) required significant tissue removal or bone repositioning with variable success rates. Modern approaches like Inspire and Genio use nerve stimulation to keep airways open - less invasive, higher success rates, better long-term outcomes.
Surgical Options Ranked by Success Rate & Invasiveness
Inspire Therapy (Hypoglossal Nerve Stimulation)
⭐ RECOMMENDED - Best Balance of Success & Safety
FDA-approved implantable device that stimulates the hypoglossal nerve during sleep, keeping the tongue and airway muscles from collapsing. Nothing on your face, sleep naturally in any position.
Best For
- • AHI 15-65 (moderate to severe OSA)
- • BMI under 32-35
- • CPAP intolerant
- • Active lifestyle, frequent travelers
- • Want permanent solution
Not Suitable If
- • Complete concentric collapse on sleep endoscopy
- • Central sleep apnea
- • Severe obesity (BMI >35)
- • Neuromuscular disease
Procedure: 2-3 small incisions (chest, neck, under chin). Outpatient surgery, 2-3 hours. Device activated 2-4 weeks later. Titration over 2-3 months to optimize settings.
Insurance: Covered by Medicare and most commercial insurance after documented CPAP failure. Dream Sleep Medicine is an Inspire Care Team of Excellence.
Genio Therapy (Bilateral Hypoglossal Nerve Stimulation)
⭐ NEWER OPTION - Single-Incision Alternative to Inspire
FDA-approved 2023. Similar concept to Inspire but stimulates BOTH sides of hypoglossal nerve, requires only single chin incision, no chest implant. Battery lasts 2+ years and recharges through skin.
Advantages Over Inspire
- • Single incision (chin only)
- • No chest implant
- • Bilateral stimulation (both sides)
- • May work for some patients who don't qualify for Inspire
Disadvantages
- • Newer device (less long-term data)
- • Battery needs recharging every few nights
- • Lower AHI reduction vs Inspire (40% vs 79%)
- • Insurance coverage still expanding
Best for: Patients who want nerve stimulation but prefer single-incision procedure, or those who don't meet Inspire anatomy requirements. Dr. Jain offers both Inspire and Genio - we'll help determine which fits your anatomy better.
UPPP (Uvulopalatopharyngoplasty)
Traditional Soft Tissue Surgery
Surgical removal of excess soft tissue in the throat (uvula, soft palate, tonsils). Widens the airway permanently but results vary widely based on patient anatomy.
Pros
- • One-time procedure (no device)
- • Permanently widens airway
- • Can reduce snoring significantly
- • Insurance typically covers
Cons
- • Only 40-60% success rate
- • Severe pain (2-3 weeks)
- • Swallowing difficulty for weeks
- • Voice changes (nasal speech)
- • Can't be easily reversed
Recovery: 2-3 weeks of severe throat pain, liquid diet, narcotics needed. Return to work 2-3 weeks.
Best for: Young patients with obvious airway obstruction (large tonsils, elongated uvula) who want one-time surgery and accept variable success rates. Less commonly recommended now due to advent of Inspire/Genio.
MMA (Maxillomandibular Advancement)
Most Effective But Most Invasive
Surgical repositioning of upper and lower jaw forward to enlarge entire airway. Requires breaking and moving both jaws, wired shut during healing. Most effective surgery but extremely invasive.
Pros
- • Highest success rate (80-90%)
- • Addresses skeletal airway restriction
- • Permanent anatomic change
- • Can improve facial aesthetics
Cons
- • Extremely invasive (breaks both jaws)
- • 6-12 weeks recovery time
- • Facial numbness (temporary/permanent)
- • Changes facial appearance
- • Requires oral surgeon + hospital stay
- • $40,000-$60,000 cost
Recovery: Jaw wired shut 6-8 weeks, liquid diet, 3-6 months full recovery. Significant facial swelling for weeks.
Best for: Severe OSA with obvious skeletal deficiency (recessed jaw), failed all other treatments including Inspire, young patients who want definitive cure. Typically last resort given invasiveness.
Nasal Surgery (Septoplasty, Turbinate Reduction)
Adjunctive - Rarely Cures OSA Alone
Corrects nasal airway obstruction (deviated septum, enlarged turbinates, nasal polyps). Can improve airflow and CPAP tolerance but rarely cures OSA by itself.
Best as: Combined with other treatments. Improves CPAP tolerance (reduces pressure needs), or prepares patient for Inspire/Genio by optimizing nasal breathing. Sleep endoscopy helps determine if nasal surgery will help.
Recovery: 1-2 weeks, relatively minor compared to other surgeries.
How to Choose the Right Surgery
Surgery selection depends on multiple factors:
Sleep Study Results
AHI severity, OSA type (obstructive vs central), sleep position dependence, oxygen levels. Inspire works for AHI 15-65, MMA for any severity, UPPP for mild-moderate.
Anatomy Assessment
Physical exam, sleep endoscopy (camera while sedated), imaging. Identifies obstruction level - tongue base (Inspire/Genio), soft palate (UPPP), jaw structure (MMA), nasal (septoplasty).
BMI & Weight
Inspire requires BMI under 32-35. Genio similar. MMA works at any weight. UPPP success drops significantly with obesity. Weight loss improves all surgical outcomes.
Lifestyle & Priorities
Fast recovery (Genio/Inspire). Maximum effectiveness (MMA). One-time surgery no device (UPPP/MMA). Travel frequently (Inspire/Genio). Cost concerns (varies by insurance).
The Surgery Selection Process at Dream Sleep Medicine
Comprehensive Sleep Evaluation
Sleep study (if not done), review existing data, assess OSA severity and type, evaluate cardiovascular risks, medication review.
Anatomic Assessment
Physical exam (Friedman staging, Mallampati score, nasal patency), sleep endoscopy (drug-induced sleep with camera to visualize collapse patterns), sometimes CT imaging for jaw assessment.
Candidacy Discussion
Present options you qualify for, honest success rate discussion, recovery comparison, insurance coverage review, answer all questions.
Shared Decision-Making
You choose based on your priorities. We don't push any particular surgery - we present evidence and let you decide what matters most (effectiveness, recovery, lifestyle fit).
Pre-Authorization & Scheduling
We coordinate documentation with the surgeon's office for insurance approval, assist with surgical facility coordination, and manage pre-op optimization (weight loss if needed, CPAP trial documentation for Inspire).
Dr. Jain's Approach: Evidence-Based, Patient-Centered
As a Stanford-trained sleep physician and Inspire/Genio Care Team of Excellence physician, I've seen hundreds of surgical outcomes. My goal is presenting honest data about success rates, recovery, and risks so you can make an informed decision aligned with your values and lifestyle.
Surgery isn't always the answer - sometimes optimizing CPAP with different masks, adding positional therapy, or treating underlying issues (allergies, weight, sleep position) works better. We explore all options before recommending surgery.
Determine Your Surgical Candidacy
Schedule a comprehensive evaluation to determine which surgical option offers the best balance of success, recovery, and lifestyle fit for your unique situation.
Schedule Surgical ConsultationCall (214) 308-1525 | Frisco, TX
Common Questions about Sleep Apnea Surgery
Ready for Better Sleep?
Schedule a consultation with Dr. Jain to discuss your treatment options and get personalized care.
Contact Us (214) 308-1525Dream Difference
- Average wait time: Days, not months.
- AASM Accredited Lab
- Interpreted by Board Certified Sleep Specialists