Obstructive sleep apnea (OSA) – the blockage of the airway during sleep – is much more common than you might think. Today about one in four men and one in 11 women have OSA, which frequently occurs as a result of the tongue falling back in the throat during sleep, blocking the airway and preventing oxygen from going to the blood. When this occurs, for some, hundreds of times per night, the brain wakes up the body to take a breath. This resulting poor quality of sleep can have negative health effects.
“OSA puts pressure on the heart, raises blood pressure and increases the risk of stroke,” said Khalid Ismail, MD, Director of the Center for Sleep Medicine at Tufts Medical Center. “It can also result in daytime sleepiness that may affect professional and social lives, as well as the ability to drive safely.”
Symptoms of OSA
The main symptom of sleep apnea is hard to miss: loud snoring.
“Snoring is an indication that the airway is narrower than it should be, but since it is very common, most people usually don’t pay much attention to it,” noted Dr. Ismail. “Not everyone who snores has OSA, but if snoring is associated with a snorting noise, gasping or witnessed stopping of breathing, then an appointment should be made to see a sleep medicine specialist.”
A sleep specialist will evaluate a patient and may recommend a sleep study to make an official diagnosis. The most common treatment for OSA is called CPAP (continuous positive airway pressure), a device that blows air under pressure and pushes soft tissues aside during sleep. The intervention is usually very effective, according to Dr. Ismail, as it opens up narrowing at various sites of the airway – the nose, throat and behind the tongue. However, CPAP has its disadvantages. Wearing a mask to sleep can feel uncomfortable and clunky, and the sounds the device emits can be disruptive to light sleepers.
An alternative sleep therapy
The newest option for eligible OSA patients is hypoglossal nerve stimulation, also known as Upper Airway Stimulation (UAS). UAS, offered by Inspire Medical Systems, is an FDA-approved, implantable, mask free treatment option for people with moderate to severe obstructive sleep apnea who are unable to use or get consistent benefit from CPAP, and for those who don’t have any other effective alternatives. Tufts Medical Center is the first in the Boston area to offer the new therapy.
How does UAS work?
The device is controlled by a small handheld sleep remote, which allows you to turn it on before bedtime and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.
While you’re sleeping, Inspire monitors every breath you take, and based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.
Some benefits of UAS include:
- Better quality sleep
- More alert during the day – improved ability to concentrate and function
- Reduction in snoring
- Improved quality of life
- Reduction of risk of heart and brain related side effects
Inspire’s UAS therapy has been found to be incredibly successful – in a study of 126 OSA patients, patients experienced a 78% reduction in sleep apnea events per hour at their three year follow up and 85% of bed partners reported no snoring or soft snoring from their bed partner using UAS therapy at their four year follow up. As of June 2017, there are 36 peer-reviewed publications on the safety and efficacy of Inspire.
What you can expect
The device is implanted during an outpatient procedure under general anesthesia – patients go home the same day with no dietary restrictions. Recovery is much quicker and pain is much less than other surgical procedures for OSA, but some temporary pain and discomfort may be felt at the small incision sites following the surgery. This is generally managed with over-the-counter pain medication. The Inspire implant will be activated for daily use one month after surgery, and a routine sleep study is performed 4-6 weeks after activation to optimize your implant settings. Once the device is implanted, the patient has it for life – a simple swap-out procedure to replace the battery will be needed every 10 years or so.
How to qualify for Inspire
UAS is a second line therapy for people who can’t tolerate or don’t benefit from CPAP, and for those who have no other effective alternatives. You may be a good candidate for Inspire if:
- You been diagnosed with moderate-to-severe obstructive sleep apnea
- You struggle with or are unable to get consistent benefit from CPAP
- You are at least 22 years of age
- You are not significantly overweight
If you meet all of the eligibility requirements, your doctor will need to confirm that you have moderate-to-severe OSA. If you have not had a recent sleep study, you may need to have a new one. Then your doctor will assess your airway anatomy using a simple outpatient procedure under light sedation. After your assessments are complete, your doctor will work with your insurance company to gain insurance coverage on your behalf. Once insurance coverage is confirmed, your surgery will be scheduled.
“The most important thing to remember is that sleep apnea is a serious condition that should be addressed as soon as possible,” stressed Dr. Ismail.
To see a sleep therapist at Tufts Medical Center, call 866-613-4535.