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Surgery For Sleep Apnea

We offer many surgical options to treat sleep apnea for patients who cannot tolerate CPAP therapy. Because airway pattern and severity of obstruction can be different for each patient, your surgeon will help you find the right treatment. Sometimes a combination of procedures is needed. 

Procedures our ear, nose and throat surgeons perform include:

  • Hypoglossal nerve stimulation (HGNS): An electrode is surgically attached to the nerve that controls the tongue muscle. This electrode is then stimulated with a pacemaker. This helps keep the airway open and the tissue and tongue from collapsing during sleep.
  • Septoplasty turbinate reduction and nasal valve stabilization: During this operation, the cartilage on the interior of the nose is straightened. The turbinates (curved bones along the nasal passage) are then reduced to make the airway bigger. In addition, nasal valves can be repaired to address valve collapse and nasal vestibular stenosis (narrowing of the nasal inlet resulting in airway obstruction).
  • Adenoidectomy: Used for people with swollen adenoids (lymph tissue that sits between your nose and the back of your throat in your upper airway).
  • Tonsillectomy: This procedure involves surgical removal of the tonsils. This is recommended for people with large tonsils who have sleep-disordered breathing. 
  • Removal or alteration/shortening of the uvula and soft palate: Removing the uvula, the soft structure that hangs down from your soft palate, can help with snoring. This may include uvulopalatopharyngoplasty (UPPP), a minimally invasive surgery designed to open up the soft palate and shorten the uvula when airway obstruction occurs at this level.
  • Minimally invasive techniques: These are performed in the doctor's office under local anesthesia to address issues with the nose, palate and/or base of the tongue. 
  • Tongue repositioning techniques: This includes hyoid (a bone that supports the tongue) and base of tongue suspension, as well as robotically assisted surgery to ease obstruction caused by an enlarged the base of the tongue.   

Inspire Therapy

diagram of implanted Inspire deviceInspire upper airway stimulation therapy is an FDA-approved implantable treatment option for people with obstructive sleep apnea who do not tolerate or benefit from continuous positive airway pressure therapy (CPAP). UC San Diego Health is one of the only health care providers in San Diego to offer this breakthrough treatment.

While you are sleeping, Inspire monitors every breath you take. Based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.

Inspire therapy is controlled by a small handheld sleep remote that you can turn on before bed and off when you wake up. You can also increase and decrease the strength of stimulation and pause during the night if needed.

The Inspire system is usually implanted during an outpatient procedure and most patients return home the same day. About one month after activation, patients undergo a sleep study to customize their Inspire therapy

Who Can Benefit from Inspire Therapy?

Patients are evaluated at our Sleep Medicine Center and are considered candidates for Inspire therapy if they:

  • Have been diagnosed with moderate to severe OSA with an apnea-hypopnea index (AHI) between 20-65
  • Struggle with or cannot get consistent benefit from CPAP treatment
  • Are not significantly overweight

Head and neck surgeon Paul Schalch Lepe, MD, FACS, performs the procedure to implant the Inspire device.