Sleep Apnea Timeline: Throat Surgery

Throat surgery for sleep apnea removes or reshapes tissue that crowds the airway, such as large tonsils, the soft palate and uvula, or the base of the tongue. Recovery is painful for about two weeks, and a sleep study about six months later shows how much the sleep apnea has improved.

This page is one of seven treatment-track timelines for adult obstructive sleep apnea. The sleep study, how a track is chosen and how to read the outcomes row are covered on the sleep apnea treatment timelines page. The operations themselves are described on the throat surgery for snoring and sleep apnea page and the sleep apnea and snoring treatments page.

Who follows this track

• Adults with large tonsils: tonsillectomy, with or without reshaping the palate, can be considered early, because it often works well (see tonsil and adenoid problems).

• Others: surgery on the palate or tongue is generally considered after CPAP and an oral appliance have not worked or have been declined. The shape of the throat matters: when the palate and tongue sit low and the tonsils are visible, palate surgery works much better than when the tongue is high and crowds the view of the throat. Palate surgery alone seldom brings moderate or severe sleep apnea back to normal, so procedures are often combined (multilevel surgery).

• Nasal surgery (septum straightening, turbinate reduction) is often added to ease nasal breathing; on its own it changes the AHI little but improves sleepiness and can make CPAP much easier to use.

Before surgery (weeks 2 to 8)

An ENT exam stages the palate, tonsils and tongue position, often with a scope through the nose. Many surgeons add a drug-induced sleep endoscopy (DISE) to map where the airway collapses during sedated sleep, and medical clearance is arranged.

Surgery and recovery

• Surgery day: under general anesthesia. Many people with moderate or severe sleep apnea stay overnight for monitoring.

• Weeks 1 to 2: throat pain is the main symptom and lasts about two weeks after tonsil surgery, often with ear pain. Soft foods are common, though a regular diet has not been shown to increase pain or bleeding.

• Days 5 to 10: the usual window for bleeding as the scabs come off; bleeding happens in about 3 in 100 after tonsil surgery, and staying near medical care for about two weeks is common. Readmission for bleeding after palate surgery is about 2 in 100.

• Weeks 2 to 4: back to a normal diet and activity.

• Months 1 to 3 after tongue-base surgery: soreness, altered sensation, taste change and dry mouth generally settle.

• About month 6: a sleep study shows the result.

Long-term effects

After palate surgery, some people notice a lump feeling in the throat (about 3 in 10 in a long-term survey), dry throat (about 1 in 4), some swallowing difficulty (about 1 in 6), voice change (about 1 in 10), taste change or liquid occasionally coming up into the nose (each about 1 in 12). Serious complications after palate surgery are uncommon, about 1.5 percent.

Outcomes on this track

Results depend heavily on the operation and on the person's anatomy and weight.

• Tonsillectomy in adults with large tonsils: the AHI fell from about 40 to 14 on average, with surgical success in about 85 percent and an AHI under 5 in about 57 percent; results were even better when the starting AHI was under 30. The Epworth score fell from 11.6 to 6.1. In a 12-year follow-up, sleepiness stayed improved and 8 in 10 would choose surgery again, although the sleep apnea had partly returned in many.

• Modified palate surgery in carefully selected people (favorable throat shape, body mass index under 36): in a randomized trial, the AHI fell from 53 to 21 at 6 months (a 60 percent drop, compared with 11 percent without surgery), was 24 at 2 years and 39 at 8 years. The Epworth score fell from 12.5 to 6.8 at 6 months and was still about 6 at 8 years; sleep-related functioning improved in 8 of 9 areas.

• Palate surgery in general: success in about 2 in 3 in the short term, falling to about 4 in 10 over the long term; in older studies of unselected patients, about 4 in 10.

• Newer palate techniques (expansion or barbed-suture pharyngoplasty): success of about 8 in 10 or more in published series, with temporary swallowing difficulty or stitch problems in up to about 1 in 5.

• Tongue-base reduction (robotic or plasma-wand, usually with palate surgery): the AHI fell from 44 to 18, success in about 2 in 3, Epworth from 12.9 to 5.8.

• Multilevel surgery after CPAP had failed: in a randomized trial, the AHI fell from 48 to 21 at 6 months, compared with 45 to 35 with ongoing medical care, and the Epworth score from 12.4 to 5.3. Improvement lasted at about 3½ years, but many people still had moderate sleep apnea.

"Success" means the AHI fell by at least half and to below 20. These are averages from groups of people, not a prediction for any one person.

Check-ups and long-term care

• Recovery visits in the first weeks, a sleep study at about 6 months, then yearly.

• If sleep apnea remains, CPAP (often easier at a lower pressure), an oral appliance, the Inspire implant or more surgery may follow.

• Benefits can fade over years, especially with weight gain; a repeat study is common if snoring or sleepiness return.