Surgery is considered when the more conservative methods of treatment fail. One method for reducing the vibrations of the soft palate that produce snoring is Laser Assisted Uvula Palatoplasty or LAUP. This procedure may be performed under local anesthesia and is performed with a laser beam that incises the soft palate in a slightly oblique fashion on each side of the uvula. As the incisions heal the soft palate becomes tighter and the uvula slightly less prominent. However, this technique may improve snoring without improving the sleep apnea. As a result, fewer cases are being performed using this technique. In addition, patients would complain of significant pain post operatively. Radiofrequency tissue ablation, also known as somnoplasty, is a procedure where a temperature controlled radiofrequency current is delivered to the center of the soft palate, above the uvula. This results in tightening of the palate and some reduction in size of the uvula. Advantages of this procedure are that it is an office procedure performed under local anesthesia for snoring and minimal sleep apnea. The same principle of treatment has been applied to treat the base of the tongue enlargement that produces obstruction when you sleep on your back. Somnoplasty of the tongue base is usually combined with another form of surgical treatment. A drawback is that it is usually necessary to repeat the procedure more than once at suitable intervals.
In those patients who find it difficult to adjust to CPAP after a suitable period of time, a surgical procedure would be discussed assuming there are no medical problems that would compromise the patient’s well being. Severe cardiovascular disease or morbid obesity would a contraindication. The most widely performed surgery for obstruction involving the area of the soft palate, uvula and tonsils is the uvulopalatopharyngoplasty known as UPPP with removal of the tonsils if present. Success with this procedure depends on many factors. If the sleep apnea is mild but less than moderate, UPPP alone does very well. If the snoring is not completely eradicated, the bed partner often will comment "there is still some snoring, but it’s much improved". If a post surgical sleep study reveals a 50% improvement in the apnea values, this is also considered a successful outcome. However, some patients find it necessary to continue CPAP therapy after their surgery.
Nasal surgery may be necessary for proper breathing through the nose. A deviated septum, enlarged turbinates or nasal polyps may interfere with obtaining maximum benefit from CPAP therapy. Although correction of a compromised nasal airway does not necessarily cure sleep apnea, an improved air flow eliminates one area of resistance.