Evaluations for Sleep Surgery are offered by Dr. Michael Awad. With surgical training specifically aimed at tailored treatments plans for sleep apnea, Dr. Awad brings the world-renowned knowledge developed at Stanford University over the last 35 years to Ontario for the first time.
All photos courtesy of Stanford Sleep Surgery
• Obstructive Sleep Apnea
• Nasal Obstruction
Upper Airway Stimulation
An exciting and emerging treatment for Moderate to Severe OSA, Upper Airway Stimulation (UAS) makes use of a small device placed during a same-day procedure. While you sleep, the device opens the airway allowing you to continue breathing normally and eliminating disruptive snoring. UAS is currently available in the United States where it was FDA Approved in 2015. Dr. Awad has one of the most extensive experiences in the world with this procedure, and offers it to eligible patients at his practice at Northwestern University in Chicago, a top 10 US Hospital, a short hour and a half trip by flight from Toronto.
A schematic demonstrating the components of Upper Airway Stimulation therapy.
When considering the treatment options for sleep apnea, the choices can be overwhelming. The key to choosing the right treatment is working with an experienced provider who can help you identify the precise sites of obstruction that lead to your sleep apnea. While overnight sleep studies are extremely valuable in identifying sleep apnea, they do not provide insight as to the specific anatomic site of obstruction. Sleep endoscopy makes use of a thin flexible camera introduced into the nose in a simulated sleeping condition to visualize the airway in real-time while you sleep.
A variety of nasal surgeries can be used to improve both daytime and sleep-related breathing. A number of these procedures can be offered in-office, improving nasal obstruction and tolerance of positive airway pressure (CPAP).
Normal Nasal Airflow
Turbinates are small bony structures covered by a skin-like lining. They are responsible for humidfying and cleansing air as it passes from the nose to the lungs. They can become swollen for a variety of reasons, including allergies or other environmental irritants. This can lead to nasal obstruction and mucous production.
Radiofrequency Turbinate Reduction is an in-office procedure in which a needle-like instrument is inserted into the turbinate and using a low-heat energy, produces shrinkage of the nasal turbinates to improve nasal airflow in a painless procedure that lasts less than 5 minutes. Post-operatively, patients can expect crusting for 2-3 weeks which self-resolves and we recommend the use of nasal saline washes during this time.
Turbinates (Normal and Abnormal)
Turbinate Reduction (In Office)
Airflow after Turbinate Reduction
Palate and Tongue Surgery
A number of modernized procedures can be used to increase airway tension and reduce the volume of tissue obstructing the airway at the back of the throat, and in the tongue in patients with sleep apnea.
See Dr. Awad’s publication on this tissue-preserving technique for more information here.
Snoring can be bothersome, and in some series has been shown to lead to marital discord. Palate radiofrequency is an in-office procedure, performed with local anesthesia that can be used to improve snoring. A needle-like instrument is inserted into the soft palate, and a low-heat energy creates shrinkage of the soft tissues which are responsible for vibrations leading to disruptive snoring. Typically, 2-3 sessions are required for optimal results.
Maxillomandibular Advancement is a form of facial skeletal surgery used to advance the jaws expanding the airway through incisions inside the mouth.