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CONSIDERING SURGERY FOR SNORING?

Before determining whether surgery is appropriate, consider the cause of the snoring. Pure snoring is the vibration of tissues in the airway, whereas with obstructive sleep apnea, blockages occur repeatedly somewhere in the airway. Of course, not everyone who snores has sleep apnea--and not everyone who has untreated sleep apnea snores--but snoring is a common symptom of sleep apnea. Before undergoing surgery for snoring, it is wise to consider if sleep apnea is present. Untreated sleep apnea can be harmful to your health, and eliminating the snoring does not necessarily eliminate the apneas.

Some people snore only in certain situations, for example, when they have nasal congestion and cannot breathe through their mouth (people who breathe through their mouth are more prone to snore). Likewise, people who have deviated nasal septums or blocked nasal passages from other causes are more likely to snore. Sleeping flat on the back or drinking alcoholic beverages close to bedtime also induces snoring. (Such situations may induce apneas as well.) A thorough evaluation and sleep study can determine whether the snoring is associated with apneas and, if so, the severity of the sleep apnea.

Generally deemed cosmetic, surgery for snoring is rarely covered by insurance policies and may be a significant expense. Most surgical procedures for snoring can be conducted in a physician's office under local anesthetic. (People with sleep apnea must be cautious about general anesthesia--no matter for what medical condition the surgery is done--because of the effects anesthesia has on the airway. For more information on this, see our publication list, in particular Sleep Apnea and Same-Day Surgery.) Pain from the surgeries varies.

One common surgery for snoring is the laser-assisted uvulopalatoplasty or LAUP, a modification of the uvulopalatopharyngoplasty, or UPPP procedure. It is also occasionally performed for sleep apnea. In the LAUP, the surgeon uses a laser to cut away the uvula, the tissue that hangs from the middle of the back of the roof of the mouth (from the Latin word "uva" meaning "grapes"). More than one session may be needed.

Another but relatively new surgical procedure for snoring, also typically done in the doctor's office, is radio frequency tissue ablation (RFTA) with the trade name Somnoplasty. Approved by the Food and Drug Administration (FDA) in July of 1997, it is to shrink the uvula. Like LAUP, more than one session may be needed. RFTA is still viewed as a new procedure, and relatively little published data on the procedure are currently available. An even newer type of tissue ablation which can be used for snoring (known by the trade name Coblation-Channeling) was approved by the FDA in February, 2000. It likewise uses radio frequency energy to shrink tissue in the airway; it can also remove tissue. However, it is not temperature-controlled, and to date, nothing on the efficacy of this procedure has been published in a peer-reviewed, scientific journal.

Another surgical system designed to treat snoring (as well as obstructive sleep apnea) was approved by the FDA in February 1998. Known as the tongue suspension procedure (with the trade name Repose), it is intended to keep the tongue from falling back over the airway during sleep with a small screw inserted into the lower jaw bone and stitches below the tongue. Usually performed in conjunction with other procedures, this surgery is potentially reversible. No studies on the long-term success are available, and little clinical data to demonstrate the efficacy of the procedure have yet been published in a peer-reviewed journal.

Nasal surgery to remove obstructions in the nose or to correct a deviated septum may also be done. (This surgery, because it can also improve breathing during the day, is typically covered by insurance.) These are likely to treat snoring successfully when there is significant blockage in the nose and nowhere else. Other surgeries for snoring include major ones such as that to advance the jaw.

Ask your doctor what surgery, if any, may be appropriate for your anatomy and what risks are involved. Also consider whether data on the safety and efficacy of the surgical procedure have met the key standard of being published in a scientific, peer-reviewed journal and, if so, whether the cases studied are similar to yours. The effectiveness varies from person to person. If unsure about proceeding, consider getting a second opinion. Only a doctor who has examined your airway can advise you on having surgery.

Because snoring can be a symptom of sleep apnea and because approximately ten million Americans have undiagnosed sleep apnea, snoring cannot be ignored. As a general rule, snoring that does not respond to simple remedies, including non-surgical ones, should be discussed with a physician or sleep specialist. Loud snoring coupled with periods of silence must be brought to a doctor's attention.

If you do have sleep apnea, it can be diagnosed and treated, with surgery or without. Which option is right for you depends upon the severity of your sleep apnea and other aspects of your medical condition. Talk to your doctor about what is best for you, and remember that your doctor may take a step-wise approach to treatment.

Physicians who perform surgery for snoring are most commonly otolaryngologists (specializing in the ears, nose, and throat) and oral and maxillofacial surgeons. If you are seeking a referral to a surgeon or a second opinion, you may find one through your physician or through a sleep center. Keep in mind that your insurance policy may require you to get a referral for a specialist and/or to see a specific provider.


As a non-profit organization, the American Sleep Apnea Association does not endorse or recommend any company, product, or health care provider.
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