Sleep apnea is a sleep disorder in which a person repeatedly stops breathing while asleep. These gaps in breathing are called apneas. Sleep apnea is usually accompanied by snoring. Obstructive sleep apnea (OSA) occurs when there is collapse of the upper throat tissues, blocking the passage of air. Individuals with this condition are rarely aware of having any breathing problem, even upon awakening. An estimated 15% of men and 6% of women in the U.S. have clinically significant obstructive sleep apnea, adversely affecting daytime cognitive functioning, cardiovascular risk, or both.
Continuous Positive Airway Pressure (CPAP) is a machine that applies air pressure through a mask (over the nose or face), which, if worn while sleeping, keeps the airway open. Many people find the masks bulky and uncomfortable, choosing instead to leave their apnea untreated. Most people with obstructive sleep apnea are not treated at all, and fewer still wear CPAP consistently enough to get its full benefit. Custom oral appliances are less effective than CPAP.
Recently published in the New England Journal of Medicine, Strollo et al published the results of a multicenter cohort study, that showed there may be a new and exciting treatment option. The investigators studied subjects with moderate to severe OSA and non-adherence with CPAP. Subjects were taken to surgery (about a two-hour procedure) for implantation of the Inspire device, an implantable pulse generator of the hypoglossal nerve (the nerve in your neck that controls those muscles that keep the airway open), and then followed for one year.
The researchers found significant reduction (68% better) in apneas and hypopneas, improved sleep quality, and 75% of subjects had a significant decrease in the number of times oxygen dropped during sleep.
The FDA is currently deciding on whether to approve of this device but it is already approved and in use in Europe. It should be noted that the Inspired device did not “cure” the sleep apnea, but neither does CPAP.
This could be a good addition to the treatment options, especially for CPAP-averse patients or patients at high cardiovascular risk. The price tag is substantial, especially when combined with surgical and hospital fees.