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An Implantable Alternative to CPAP for Sleep Apnea

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If you or your bedmate suffers from obstructive sleep apnea and you’re using a continuous positive airway pressure (CPAP) device, you know it works well, but you probably can’t stand it. As much as you would like to fantasize that you are geared up for a scuba-diving adventure as you lapse off to dreamland with that mask and hose attached to your face, the CPAP contraption is uncomfortable, noisy and unattractive. You wonder whether the remedy is worse than the disease. In fact, maybe you have a CPAP machine that you simply no longer use. Even though obstructive sleep apnea is associated with cardiovascular disease, liver disease, fatigue and cognitive impairment, you’ve decided not to wear that thing.

Finally, there is an alternative to a CPAP machine.

BE THE BIONIC MAN, NOT JACQUES COUSTEAU

As you may know, in obstructive sleep apnea (OSA), breathing temporarily stops several times a night—even several times an hour. It happens because the throat muscles relax too much, allowing the soft palate, the uvula and tongue to sag and block airways. OSA episodes usually last 10 to 20 seconds, sometimes much longer, and this loss of breath can cause dangerous drops in blood oxygen levels. When your brain senses the blocked breathing, it’s rigged to wake you up. So you’ll find yourself waking with a snort, a gasp or a reflexive jerk to kick-start the breathing process again. And this is the cycle over and over again all night for people with OSA who don’t get treatment or who get a CPAP device but don’t wear it.

AN ALTERNATIVE FOR THE STUBBORN

Although CPAP has a near 100% rate of effectiveness in preventing OSA, it’s not effective unless it is actually used, of course. “Nonadherence”—the medical term for flipping off doctors’ orders—is high when it comes to CPAP use. Up to 83% of CPAP owners use the device less than four hours per night. That’s nowhere near enough to be protected against OSA complications already mentioned—cardiovascular disease and liver dysfunction, daytime sleepiness and fatigue and problems with memory and concentration.

If you have OSA and you’re having trouble sticking with CPAP, an alternative now is available called Inspire Upper Airway Stimulation. It’s not as effective as CPAP but may be close enough and much easier to live with—and it’s far better than nothing at all.

There is a drawback—the Inspire device requires a two-and-a-half-hour surgical procedure in which a small neurostimulator is implanted into a spot on your chest just below the collar bone. The device is then literally wired to your hypoglossal nerve and intercostal muscles. (The hypoglossal nerve runs along the jawline and controls the movement of the tongue, and the intercostals surround your ribs and control the movement of the chest wall.)

Inspire Upper Airway StimulationThe device is calibrated, adjusted and controlled via telemetry, which means that you and your doctor communicate with it via radio waves. You also have to learn how to use a handheld controller to turn it on and off. (Yes, now you are part machine.) When the device senses a problem with your breathing, it stimulates the hypoglossal nerve and intercostal muscles to make your tongue and chest move to keep airways open.

A recent study of 126 patients with moderate-to-severe OSA who would not use CPAP showed that the Inspire device was effective in preventing OSA episodes. It reduced sleep apnea by 68%—from an average of 29 events per hour to nine events. In turn, it prevented dangerous dips in blood oxygen levels by 70%. The oxygen desaturation index (ODI), a measure of how often blood oxygen levels fall four or more points below normal, decreased from an average 25 episodes per hour to seven.

As for more on the surgical rigmarole, 95% of patients in the study went home the same day or the day after the procedure. Not bad. The device was activated a month after implantation, which was when patients were trained in how to use the controller.

Most adverse effects had to do with weakness or soreness of the tongue because of stimulation of the hypoglossal nerve or from rubbing continually over the lower teeth or else general discomfort from nerve stimulation, but these problems went away either after patients adjusted the device or simply got acclimated to it. Two patients experienced serious discomfort, which was remedied by adjusting the placement of the device, which required another surgical procedure.

IS IT RIGHT FOR YOU?

The Inspire device was recently approved by the FDA for people with moderate-to-severe OSA. The implantation procedure is performed by an otolaryngologist, who will also calibrate and adjust the device. Be forewarned that the doctor you consult—whether it be an otolaryngologist or respiratory or sleep specialist—will first either want you to try CPAP if you haven’t already or else try to optimize your CPAP by seeing if you need a better-fitting or quieter model or more training in how to most effectively use your CPAP machine. That’s because CPAP, as mentioned, is the most effective way to control OSA and is less expensive and less risky than surgery.

That said, if you are averse to dealing with CPAP but have the motivation to undergo a surgical procedure that will implant a device in your chest that you need to remember to turn on each night, and off each morning, Inspire may be right for you.

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Source: Study titled “Upper-Airway Stimulation for Obstructive Sleep Apnea,” published in The New England Journal of Medicine. Date: November 3, 2014 Publication: Bottom Line Health
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