Medical Surgical Obstructive Sleep Apnea (OSA) #4

Question

A client with obstructive sleep apnea (OSA) has decided to seek surgical treatment since he is unable to tolerate CPAP. Uvulopalatopharyngoplasty (UPPP) has been suggested by his provider. Which explanation by the nurse best describes this procedure?

Answers

  1. “The surgeon implants a neurostimulator in the chest with one lead attached to the hypoglossal nerve to simulate the tongue to move forward to open the airway when obstruction is sensed.”
    • Rationale:

      This answer is not correct because this describes a hypoglossal nerve stimulator implant. This is the latest surgical option for treatment of obstructive sleep apnea.

  2. “A permanent opening is created in the neck to the windpipe by the surgeon and a tube is inserted to allow air in with a valve that you open at night so air can go around the blockage while you sleep.”
    • Rationale:

      This answer is not correct because this is a tracheostomy. This option for OSA is reserved for clients with severe disease and as a last resort after the other measures have failed since it requires significant lifestyle changes and carries significant risks.

  3. “The bones of the upper and lower jaw are repositioned by the surgeon and the throat muscles are positioned in a way that creates tension to relieve airway obstruction.”
    • Rationale:

      This answer is not correct because this is the definition of maxillomandibular advancement surgery. It addresses OSA with a more comprehensive approach by repositioning both the upper and lower pharyngeal airways.

  4. “Your surgeon will remove a small piece of tissue that hangs in the back of your throat as well as removing or repositioning excessive tissue in the back of the mouth so that air can move better through the throat while you sleep.”
    • Rationale:

      This answer is correct because UPPP is removal of the uvula and excessive tissue in the throat including the tonsils. This surgery has a limited success rate and is only recommended in a few clients. OSA symptoms sometimes return after surgery. All surgical treatments require discussions about the treatment and expected outcomes and potential risks.

Overview

Surgery for OSA is an alternative for clients who cannot tolerate nonsurgical treatments. UPPP is removal of the uvula and excessive tissue in the throat including the tonsils.

Explanation

Learning Outcomes

UPPP is removal of the uvula and excessive tissue in the throat including the tonsils. This surgery has a limited success rate and is only recommended in a few clients. OSA symptoms sometimes return after surgery. Hypoglossal nerve stimulator implant is the latest surgical option for treatment of obstructive sleep apnea. It involves placing a nerve stimulator in the chest with a lead attached to the hypoglossal nerve which stimulates movement of the tongue to open the airway while the client is asleep. A tracheostomy is reserved for clients with severe disease and as a last resort after the other measures have failed. Maxillomandibular advancement surgery addresses OSA with a more comprehensive approach by repositioning both the upper and lower pharyngeal airways. All surgical treatments require discussions about the treatment and expected outcomes and potential risks.

Test Taking Tip

Before your test, eat a good breakfast of protein and complex carbohydrates. Do not eat too much, however, since when digesting a meal, your blood is shunted to the stomach, which leaves less blood for the rest of the body (brain) and can make you feel tired and unfocused.

Video Rationale