As a Sleep Physician and Surgeon, treating OSA patient is complicated. As we continue to diagnose the over 10 million Americans likely to have sleep apnea, we are adding the burden of need for good treatments. While CPAP (positive pressure delivered through a mask) is the mainstay of treatment, many of my patients continue to have difficulty tolerating this therapy, or do tolerate it initially but their compliance falls off with time. After other non-surgical options such as an oral appliance, which can cause jaw joint problems or shifting of teeth, and Provent, stickers placed over the nostrils which can be difficult to tolerate similar to CPAP and are not covered by insurance, the surgeon is left to help many of these patients. While my personal approach has moved away from destructive surgeries (i.e. cutting off palate and uvula) to more reconstructive surgeries (repositioning the tissues to allow better airflow), many surgeries involved difficult postoperative courses due the nature of operating in the throat.
Now, however, a new promising option is ready to emerge. Inspire Medical Systems has developed an implantable nerve stimulator therapy for sleep apnea. Utilizing a pacemaker device implanted in the chest wall with a electrode to detect respiration and an electrode attached to the nerve that moves the tongue forward, this therapy can detect the absence of breathing when the throat obstructs and stimulate the tongue to move forward and reopen the airway, stopping the apnea event. This hypoglossal nerve stimulator technology has been evaluated in 22 medical centers in the United States and Europe as part of the multicenter, prospective Stimulation Therapy for Apnea Reduction (STAR) trial. The first 12 month follow up results were published in the January issue of the New England Journal Medicine. The device succeeded in a 70% reduction in the severity of sleep apnea episodes as well as a reduction in daytime sleepiness for patient who had failed CPAP therapy and were enrolled into the study.
This device promises a new era of OSA treatment, offering a very tolerable surgery which is non-destructive and very effective. Take a look at the video below: