Tracheostomy

Tracheostomy is a procedure where a permanent opening is made in front of the neck region to gain direct access to the wind pipe. Tracheostomy was the first efficacious surgical procedure for treating obstructive sleep apnea in the past. It is almost 100% curative in relieving the signs and symptoms of obstructive sleep apnea because it bypasses all the potential obstructive sites in the upper airway. After tracheostomy there is a rapid and striking reduction in daytime somnolence and a marked improvement in sleep architecture due to a major reduction in the frequency of arousals. Irregular heart beat, slow heart rate, lung vasculature high blood pressure, low oxygen level, and apnea all improve dramatically with the procedure. Tracheostomy clearly is an effective surgical treatment for patients with obstructive apnea.

Disadvantages:

Permanent tracheostomy can have a devastating effect on sleep apnea patients. Almost all patients experience psychological depression from the social and medical problems associated with a lifelong tracheostomy. The tracheostomy leaves the patient esthetically disfigured and exposes the patient to common local complications such as bleeding, infection, pain, and irregular tissue formation. Patients are also at increased risk for the more serious complications of narrowing of wind pipe (tracheal stenosis) or erosion into an adjacent blood vessel.

Indications:
Because of these disadvantages and complications, a permanent tracheostomy should be reserved for severe cases of obstructive sleep apnea with significant cardiovascular symptoms. Some scientists have suggested that tracheostomy should be the primary therapy for all patients who spend substantial time in severe oxygen desaturations below 50% and for those who have life-threatening heart irregular beats during sleep apnea. Tracheostomy may also be used as an interim treatment until adjunctive procedures to reconstruct the upper airway are completed.