Introducing: Ask a Doctor
At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.
That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.
Today, let’s talk about the Airlift sleep apnea procedure!
Prepared by: Ethan Kase Maner, UTHSC Medical Student
Reviewed by: Dr. M. Boyd Gillespie, MD, MSc, FACS
First, what is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is characterized by narrowing of the upper airway during sleep, which results in difficulty breathing while resting. There are two common areas where the airway collapses, making breathing more difficult during sleep. One is the result of the back of the tongue getting too close to the roof of the mouth (palate), and another potential space for obstruction is in the lower throat (hypopharynx) right as it splits into the windpipe (trachea) and the swallowing passage (esophagus).
What is the first line of treatment for OSA?
People with moderate-to-severe OSA are typically prescribed a CPAP machine. CPAP stands for “Continuous Positive Airway Pressure,” meaning that it supplies a steady flow of oxygen into the nose and mouth during sleep encouraging the airways to remain open. However, the long-term success of CPAP is variable. Studies have shown that as low as one-half of people who use CPAP become intolerant to it.
What if a CPAP doesn’t work?
This depends entirely on where the specific obstruction in the airway is occurring. If the airway is being obstructed in the back of the oral cavity by the tongue base and palate, there are multiple surgeries/procedures available that can help improve breathing during sleep.
However, this article focuses on patients whose obstruction is in the throat (hypopharynx) right before it splits into the windpipe (trachea) and esophagus. In this case, there is a procedure available called the Hyoid AirLift.
Hyoids as indicators of an Airlift procedure:
The hyoid bone is a U-shaped bone commonly called the “floating” bone because it has no other bony attachments. However, it is attached to an essential piece of tissue called the Epiglottis. The Epiglottis is a flap of tissue that sits right above the windpipe.
Its job is to cover the windpipe while eating and drinking, so food and liquid stay out of the lungs. For people with an anatomically low hyoid bone, the Epiglottis can obstruct the airway leading to OSA.
Patients with these low hyoid bones and moderate-to-severe Obstructive Sleep Apnea are good candidates for the Hyoid AirLift.
What exactly is the Hyoid AirLift sleep apnea procedure?
For the hyoid myotomy and suspension (AirLift), the surgeon will essentially tie sutures around the hyoid bone in two locations. These suture loops will then be anchored into screws in the jawbone underneath the chin. These sutures are tightened, lifting the hyoid bone, and consequently, the Epiglottis forward and upward.
If needed, the sutures can be tightened or loosened later to accommodate airway problems.
Does the Airlift procedure work?
In a study done by our department chair Dr. M. Boyd Gillespie and others across the country, 19 patients with moderate-to-severe Obstructive Sleep Apnea underwent hyoid myotomy and suspension without any other tongue base or palatine procedures. This study was done to determine if the Hyoid AirLift alone would improve airway obstructions.
The results of this study showed that the procedure significantly (p<0.01) reduced the apnea-hypopnea index (AHI) in patients, meaning that it lessened the severity of their OSA. Another significant (p<0.01) result was an increase in patients’ lowest oxyhemoglobin saturation (LSAT). This means that after the procedure, a significant number of the patients improved the amount of oxygen saturation in their blood.
In a separate study done by Dr. Ryan Nord and others, 39 patients with moderate-to-severe sleep apnea underwent hyoid myotomy and suspension with concurrent palatopharyngeal procedures. The results of this study were remarkable.
The mean AHI was reduced by 69.2% across all patients. The median AHI was reduced from 42 (severe sleep apnea) to 10.8 (mild sleep apnea).
The Hyoid AirLift procedure is an effective treatment for patients with moderate-to-severe Obstructive Sleep Apnea (OSA).
Studies indicate that Hyoid myotomy and suspension is an effective standalone procedure in patients who meet the criteria. It is also effective when done concurrently with palatopharyngeal procedures such as uvulopalatopharyngoplasty (UPPP).