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Obstructive Sleep Apnoea (OSA) – An Overview

Understanding the Causes of Sleep Apnoea and the Surgical Treatment Options Available

Obstructive sleep apnoea (OSA) is a common condition in which breathing repeatedly stops or becomes restricted during sleep due to collapse of the upper airway. These interruptions can occur dozens or even hundreds of times each night, reducing sleep quality and placing significant strain on the body.

Left untreated, obstructive sleep apnoea may contribute to:

Dr Tom Pepper is a Consultant Oral and Maxillofacial Surgeon in London specialising in the assessment and surgical management of obstructive sleep apnoea, with particular expertise in skeletal airway surgery, maxillomandibular advancement (MMA), hypoglossal nerve stimulation, and multi-level airway procedures.

Consultations are available in London at Harley Street and Cromwell Hospital.

What Is Obstructive Sleep Apnoea?

Obstructive sleep apnoea occurs when the airway repeatedly narrows or collapses during sleep.

As the muscles relax, structures within the throat may obstruct airflow, resulting in:

Patients may be unaware these events are occurring, although partners often report loud snoring, choking sounds, or witnessed pauses in breathing.

Common Symptoms of Sleep Apnoea

Symptoms may include:

Not every patient experiences every symptom, and severity can vary considerably.

What Causes Obstructive Sleep Apnoea?

Sleep apnoea is rarely caused by a single problem. Most patients have a combination of anatomical and physiological factors contributing to airway collapse. These may include:

Jaw Position

A small or retruded upper jaw and lower jaw can reduce the space available for the tongue and soft tissues.

This may contribute significantly to airway narrowing during sleep.

Tongue Base Obstruction

The tongue may fall backwards during sleep and contribute to blockage of the airway.

Tongue-base collapse is one of the most common causes of obstructive sleep apnoea.

Nasal Obstruction

Difficulty breathing through the nose may worsen sleep-disordered breathing and reduce tolerance of CPAP therapy.

Common causes include:

Soft Palate and Tonsils

The soft palate and tonsils may also contribute to airway collapse.

This is particularly relevant in some younger patients and those with significant tonsillar enlargement.

Weight and Soft Tissue Factors

Increased soft tissue volume around the airway may increase the likelihood of obstruction during sleep.

Diagnosis

Assessment typically begins with a sleep study. This may be performed at home or within a specialist sleep laboratory.

Testing allows measurement of:

Further investigations may be recommended depending on the individual case.

Drug-Induced Sleep Endoscopy (DISE)

Not all sleep apnoea patients have the same pattern of airway collapse. Drug-induced sleep endoscopy (DISE) allows direct examination of the airway during a sleep-like state.

This helps identify:

DISE often plays a pivotal role in selecting the most appropriate surgical treatment.

Treatment Options for Sleep Apnoea

Treatment should address the underlying cause of airway obstruction wherever possible.

Options may include:

The most appropriate approach depends on the patient’s anatomy, severity of disease, and treatment goals.

CPAP Therapy

Continuous Positive Airway Pressure (CPAP) remains the first-line treatment for many patients. CPAP works by delivering pressurised air through a mask worn during sleep.

Advantages include:

However, not all patients tolerate CPAP successfully. Common challenges include:

For these patients, surgical assessment may be appropriate.

Surgical Treatment for Obstructive Sleep Apnoea

Surgery is not a single procedure. Different operations target different levels of airway obstruction.

Successful treatment depends on matching the procedure to the patient’s anatomy, and sometimes a combination of procedures are necessary.

Maxillomandibular Advancement (MMA) – The Most Powerful Skeletal Procedure for OSA

Maxillomandibular advancement (MMA) involves moving both jaws forwards to enlarge the airway.

The procedure increases the space available behind:

Benefits may include:

For appropriately selected patients, MMA is often the most effective surgical treatment for obstructive sleep apnoea.

Genioglossus Advancement and Hyoid Suspension (GAHS)

Genioglossus advancement and hyoid suspension aims to:

This procedure may be appropriate as part of a multi-level surgical approach.

Tongue Base Coblation

Tongue-base enlargement contributes to airway narrowing in some patients.

Coblation uses controlled radiofrequency energy to reduce tissue volume at the base of the tongue.

Potential benefits include:

Careful patient selection is important.

Inferior Turbinate Coblation

Nasal obstruction can worsen symptoms and reduce tolerance of CPAP treatment.

Inferior turbinate coblation aims to:

Although this procedure does not typically cure sleep apnoea, it may form an important part of a comprehensive treatment strategy.

Hypoglossal Nerve Stimulation – Inspire® and Genio® Sleep Apnoea Implants

Hypoglossal nerve stimulation is an advanced treatment for carefully selected patients who cannot tolerate CPAP therapy.

The treatment works by:

Systems such as Inspire® and Genio® provide an alternative to mask-based therapy in suitable patients.

What About Palate and Tonsil Surgery?

Procedures performed by ENT surgeons for OSA may include:

These operations may play an important role in selected patients where obstruction occurs predominantly at the level of the palate or tonsils.

Dr Tom Pepper works with a multidisciplinary team involving sleep physicians and ENT colleagues to ensure treatment is targeted at the correct area and individualised carefully to each patient.

Which Operation Is Best?

There is no single best operation for sleep apnoea.

The most appropriate procedure depends on:

Many patients benefit from a personalised treatment plan rather than a standardised approach.

Frequently Asked Questions

What is obstructive sleep apnoea?

Obstructive sleep apnoea is a condition in which the airway repeatedly collapses during sleep, causing pauses in breathing and disruption of normal sleep.

Is snoring the same as sleep apnoea?

No. While many patients with sleep apnoea snore, not everybody who snores has sleep apnoea.

Can sleep apnoea be cured with surgery?

In selected patients, surgery can substantially improve or even resolve sleep apnoea. Outcomes depend on the underlying anatomy and the procedure performed.

Is MMA better than hypoglossal nerve stimulation?

These procedures address different patterns of airway obstruction and may be suitable for different patients. Assessment is required to determine the most appropriate option.

Will I still need CPAP after surgery?

Some patients can reduce or eliminate CPAP use following successful surgery, although individual outcomes vary.

How do I know which treatment is right for me?

A detailed assessment, including sleep study findings and airway evaluation, is required before making treatment recommendations.

Why Choose Dr Tom Pepper?

Obstructive sleep apnoea surgery sits at the intersection of airway anatomy, facial skeletal structure, and surgical planning.

Dr Tom Pepper is a dual-qualified Consultant Oral and Maxillofacial Surgeon trained in both medicine and dentistry, with expertise in:

Treatment recommendations are based on identifying the underlying causes of airway obstruction and selecting the most appropriate evidence-based intervention for each individual patient.

Consultation

Consultations for obstructive sleep apnoea and sleep surgery are available in London at Harley Street and Cromwell Hospital.

A detailed assessment allows review of your sleep study results, airway anatomy, previous treatments, and goals, enabling development of a personalised treatment plan tailored to your individual circumstances.

Book a Consultation

Written and medically reviewed by:

Dr Tom Pepper
Consultant Oral & Maxillofacial Surgeon
MBBS BDS MSc FRCS

Private consultations available in Harley Street and Cromwell Hospital, London.