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Ear, Nose + Throat (ENT) - Head + Neck Surgery

Upper Airway Stimulation

You can rest assured

At Tufts Medical Center in downtown Boston, we understand the value of sleep and the impact it can have on your health. That’s why the Division of Pulmonary, Critical Care and Sleep Medicine Center and the Department of Otolaryngology-Head & Neck Surgery (ENT) have teamed up to offer a new implantable therapy to treat obstructive sleep apnea (OSA) called Upper Airway Stimulation (UAS).

What is obstructive sleep apnea (OSA)?

Approximately 18 million Americans – 1 out of every 15 adults – 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 including:

  • Heart attack/failure
  • Stroke
  • Atrial fibrillation
  • High blood pressure
  • Memory loss
  • Increased motor vehicle and occupational accident risk
  • Weight gain and diabetes
  • Excessive daytime sleepiness and reduced quality of life
  • The main symptom of sleep apnea is hard to miss: loud snoring. But there are others to watch for. Do you have trouble falling asleep? Do you stop breathing for a few seconds overnight, suddenly choking or gasping for air? Are you tired even after a full night’s rest? Do you fall asleep at odd times—in meetings, in class, on the train—and feel fatigued all day? If you or your partner notice these signs, talk to a doctor.

    The most common treatment is called CPAP (continuous positive airway pressure), a device that blows air under pressure and pushes soft tissues aside during sleep. 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. That’s why we’ve teamed up with Inspire Medical Systems to introduce UAS – this new treatment eliminates all of these problems so you can concentrate solely on getting a good night’s sleep. 

    An alternative sleep therapy

    Upper Airway Stimulation 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. Inspire Medical Systems is the only company to offer UAS – the first-ever implantable device for treating OSA. More than 1,800 Inspire devices have already been implanted throughout the world as of June of 2017.

    The team assembled to provide your care is led by the Chief of the Division of Head and Neck Surgery, Richard O. Wein, MD, FACS, and the Director of the Center for Sleep Medicine, Khalid Ismail, MD. The service will implant the device and the Sleep Medicine team will activate the device, make adjustments, monitor and follow the patient from the point of implant.

    How does Inspire work?

    The device is controlled by a small handheld sleep remote, which allows you to turn it on before bed 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 Inspire 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 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 – you can read some here.

    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 whom there are 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.

    Khalid H. Ismail, MD

    Khalid H. Ismail, MD

    Title(s): Director, Sleep Medicine Fellowship Program; Co-Director, Mycobacterial Disease Clinic; Pulmonary Attending Physician; Assistant Professor, Tufts University School of Medicine
    Department(s): Medicine, Pulmonary, Critical Care and Sleep Medicine
    Appt. Phone: 617-636-6377
    Fax #: 617-636-1649

    Pediatric sleep apnea, obstructive sleep apnea, parasomnias, narcolepsy, pulmonary hypertension, lung cancer, COPD, asthma, ILD, critical care medicine, tuberculosis

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    Richard O. Wein, MD, FACS
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    Richard O. Wein, MD, FACS

    Title(s): Chief, Division of Head and Neck Surgery; Associate Professor, Tufts University School of Medicine
    Department(s): Otolaryngology
    Appt. Phone: 617-636-8711
    Fax #: 617-636-1479

    Head and neck surgical oncology, head and neck reconstruction, management of salivary and thyroid disorders, management of radiation-related complications, maxillofacial trauma, maxillofacial trauma, sleep apnea and sleep endoscopy

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    617-636-5496

    Richard O. Wein, MD, FACS is the chief of the Division of Head and Neck Surgery at Tufts Medical Center in Boston, MA.

    WCVB: New hope for those who suffer with sleep apnea

    Tufts Medical Center now offers a new implantable therapy to treat obstructive sleep apnea called Upper Airway Stimulation.

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