Sleep Apnea - Sleep Surgeries
A sleep surgery treatment plan is made once Dr. Ludwick identifies the areas of obstruction through an in-office exam and through findings made during DISE, Drug Induced Sleep Endoscopy.
The shortcoming of sleep study results is that they only tell us if a patient has significant airway obstructions during sleep. However, they do not tell us where the obstruction is occurring. The simple fact is that in patients who suffer from OSAS, their awake and asleep airway exams look completely different. If it didn’t, these patients would be snoring and obstructing all day long, not just when they sleep!
Drug-Induced Sleep Endoscopy is an endoscopic examination of the upper airway that is performed while the patient is sedated by an anesthesiologist in an operating room suite. In this controlled setting, the patient’s airway is monitored with video equipment while he or she sleeps. Snoring and airway obstructions are then observed, thus locating the source of the patient’s airway obstructions during sleep.
Dr. Ludwick performs DISE on all patients considering sleep surgery to determine where the obstruction is occurring. The exam is photo documented and reviewed with his patients. Once identified, a specific surgical plan is made to correct the obstruction. This ensures a positive result from the surgery.
Obstructions are generally categorized as either occurring at the level of the palate (retropalatal) or of the tongue (retrolingual) or both. Therefore, sleep surgical procedures are combined as needed to address each area of obstruction.
Retropalatal
Tonsillectomy (if present)
Uvulopalatopharyngoplasty (UPPPP)
Lateral Pharyngoplasty
In simple terms, these procedures involve removing the tonsils, if present, trimming the palate, and decreasing the bulk of the outside wall of the throat. All of these procedures are done in one session and will effectively address obstruction in this area.
Retrolingual
Partial Midline Glossectomy
Hyoid Suspension
Lingual Tonsillectomy
Dr. Ludwick always performs all of these procedures together, if indicated. These procedures include removing a portion of the tongue muscle that can not normally be seen, using permanent suture to help pull the hyoid bone forward away from the back wall of the throat, and removing any tonsil tissue that may be located at the back of the tongue. When done in concert, these procedures are very successful in dramatically improving the airway space behind the tongue while asleep. Believe it or not, these procedures are no more difficult to recover from than tonsillectomy. In fact, most patients find the recovery from these surgeries easier than tonsillectomy.
Inspire Hypoglossal Nerve Stimulator*
Inspire is an implantable nerve stimulator, similar to those used as cardiac pacemakers, which maintains the tongue’s muscle tone while asleep. During wakefulness, the device is inactive. Inspire has also been shown to improve space behind the palate during sleep. This procedure requires no surgical changes to the throat so the recovery is much different than that of the above procedures.
* The Inspire Hypoglossal Nerve Stimulator has been shown to be very effective, even for patients with very severe sleep apnea up to an apnea hypopnea index (AHI) of 65 events/hour.
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