Cutting-Edge Surgical Treatment for Sleep Apnea: Understanding Hypoglossal Nerve Stimulation

Review of obstructive sleep apnea and traditional treatments

Are you looking to ditch your CPAP forever? If so, you may want to check out the newest innovation for treating obstructive sleep apnea. Hypoglossal nerve stimulation, a groundbreaking surgical procedure, is emerging as a game-changer in the world of sleep medicine. This advanced treatment offers a fresh ray of hope for those struggling with sleep apnea, especially for those who find traditional CPAP machines cumbersome or ineffective. 

In this article, we’ll delve into the intricacies of hypoglossal nerve stimulation, exploring how it works, its benefits, and why it might be the key to unlocking a good night’s sleep without the hassles of conventional methods.

What is Sleep Apnea?

Sleep apnea is a prevalent sleep disorder characterized by repeated interruptions in breathing during sleep. These pauses, known as apneas, occur when the airway becomes blocked or the respiratory system fails to function correctly. 

Signs and Symptoms

Common signs and symptoms include loud snoring, abrupt awakenings accompanied by gasping or choking, morning headaches, excessive daytime sleepiness, and difficulty concentrating. 

It’s not just the noise of snoring that’s a concern; sleep apnea can lead to serious health complications like heart disease, high blood pressure, and diabetes if left untreated. Understanding these signs is crucial for early detection and effective management of the condition.

Understanding the CPAP Machine

The CPAP (Continuous Positive Airway Pressure) machine, a cornerstone in treating sleep apnea, was invented in the early 1980s.

 It delivers a steady stream of air through a mask to keep the airways open during sleep. This prevents the pauses in breathing that characterize sleep apnea. Despite its effectiveness, CPAP therapy often faces a significant challenge: patient tolerance. Many individuals find the mask uncomfortable, the machine noisy, and the experience intrusive, leading to low compliance rates. In fact, it’s estimated that a substantial number of patients either abandon CPAP use or don’t use it consistently enough to benefit from its therapeutic potential. This lack of adherence has driven the search for alternative treatments that are effective, more user-friendly, and acceptable to patients in their everyday lives.

In this article, we will be discussing the Inspire Implant. The Inspire device, which received FDA clearance in 2014, is currently the most well-known and widely used surgical implant as an alternative to CPAP therapy.

What is the Inspire Implant?

The Inspire implant, a revolutionary device in the realm of sleep apnea treatment, represents a significant milestone in the history of medical innovations for this condition. Developed as an alternative to CPAP, the Inspire system was approved by the U.S. Food and Drug Administration (FDA) in 2014 after years of research and clinical trials. It was designed to address the needs of patients who struggle with CPAP therapy, offering a less intrusive and more patient-friendly solution.

The Inspire system stimulates the hypoglossal nerve, which controls tongue movement and other airway muscles. This stimulation keeps the airway open during sleep, effectively reducing the apneas that characterize sleep apnea. 

Unlike CPAP, which requires the use of a mask and machine throughout the night, the Inspire implant is a small device placed under the skin in a minor surgical procedure. 

Once implanted, it’s controlled by a remote, allowing the patient to turn the device on before sleep and off upon waking.

Who Might be a Candidate for the Inspire Implant?

Not everyone will be a candidate for the Inspire Implant. In fact, there are some fairly specific guidelines a person has to meet to become a qualified candidate for the Inspire implant.

Let’s discuss these guidelines here:

Age and Diagnosis:

  • Adults must be diagnosed with moderate to severe Obstructive Sleep Apnea (OSA), with an Apnea-Hypopnea Index (AHI) between 15 and 100 (AHI is the average amount of times you stop breathing per hour).
  • Pediatric patients with Down Syndrome, aged 13-18, diagnosed with severe OSA (AHI between 10 and 50) are also eligible.

CPAP Therapy History:

  • Candidates should have tried and could not use or derive consistent benefits from CPAP (Continuous Positive Airway Pressure) therapy. This includes an inability to use PAP more than 5 nights per week for more than 4 hours per night or an unwillingness to use PAP. (some insurance guidelines are also now requiring a trial with oral appliance therapy as well)

Body Mass Index (BMI):

  • The Inspire therapy has been clinically tested for people with a BMI up to 32, and most insurance policies have a BMI policy in place for coverage.

Airway Examination:

  • An Inspire-trained doctor must examine the patient’s sleep study results and perform a non-surgical airway exam to assess the airway’s functionality. A sleep endoscopy, or drug-induced sleep endoscopy (DISE), is a diagnostic procedure used to evaluate the causes of snoring and obstructive sleep apnea (OSA). During this procedure, the patient is brought into a sleep-like state using sedatives. Once the patient is sedated, an endoscope, a flexible tube with a camera and light at its end, is inserted through the nose and into the throat.
  • The endoscope allows the doctor to observe the patient’s airway in a state that closely resembles natural sleep. The physician can identify the areas and structures in the airway causing obstruction, such as the soft palate, tongue, tonsils, or epiglottis. This information is crucial in deciding the most effective treatment for the patient, particularly when surgical interventions like the Inspire implant are being considered.

Exclusion of Certain Conditions:

  • The treatment is not appropriate for those with a diagnosis that includes more than 25% central sleep apnea or mixed sleep apnea and for those with complete concentric collapse at the soft palate.

Other Health Considerations:

  • The Inspire implant is not recommended for patients with conditions or procedures that have compromised neurological control of the upper airway, those unable to operate the sleep remote, pregnant women or those planning to become pregnant, and patients with specific implantable devices that may interact with the Inspire system.

MRI Compatibility:

  • Patients with the Inspire Model 3024 cannot undergo MRI, while those with Model 3028 can, under certain conditions and precautions.

These criteria ensure that the therapy is used in patients who are most likely to benefit from it and can safely manage the device. It’s important for individuals considering this treatment to consult with a healthcare provider who is experienced in evaluating patients for Inspire therapy.

What to Expect During Surgery

Duration and Procedure:

  • The implantation process takes approximately 2-3 hours in the operating room under general anesthesia. It is an outpatient procedure, meaning the patient can typically go home on the same day or the following morning.

Surgical Incisions:

  • The surgeon makes two small incisions. One incision is near the collarbone to place the implant, and the other is beneath the jawline to connect the implant to the tongue’s nerve. 

Post-Surgical Experience:

  • After the procedure, patients generally experience some swelling at the incision sites, which lasts for a few days. Most people manage post-operative pain with over-the-counter pain medication and can resume non-strenuous activities within a few days. It is important to discuss the timeline for resuming light activity and returning to work with the doctor. Some patients may experience pain while moving the tongue, numbness or weakness of their lips, or a lisp. This usually improves in 4-6 weeks.

Follow-Up and Device Activation:

  • A follow-up appointment is scheduled to activate the Inspire implant. During this visit, the patient learns how to use the Inspire remote to control the therapy and adjust the settings. The patient is instructed to go up on the voltage every week as tolerated to increase the effectiveness of the stimulation. The Inspire-trained doctor works with the patient to find the right therapy level.
  • After using the device for approximately three months, patients undergo a titration sleep study at a sleep lab to optimize the device settings. Patients are then asked to return every three to six months for a device check and monitoring. They are asked to return for an annual follow-up visit for a simple device check.

It’s essential for patients to closely follow their surgeon’s instructions and attend all follow-up appointments to ensure the best outcomes from the surgery and the Inspire device.

Does it Work?

The Inspire implant has shown significant success in treating obstructive sleep apnea (OSA) and boasts high levels of patient satisfaction. Key aspects of its success and patient satisfaction include:

  • Reduction in Apnea-Hypopnea Index (AHI): A clinical study revealed that after 12 months of using the Inspire device, 66% of participants cut their AHI scores by at least 50%. The study also found that 75% of participants experienced at least a 25% reduction in the oxygen desaturation index (ODI), with the median AHI score decreasing by 68% and the median ODI score falling by 70%.
  • Effectiveness in Treating OSA: The Inspire implant can effectively treat 70-80% of patients with moderate to severe OSA. This is significant, considering CPAP therapy is the gold standard for OSA treatment.
  • Patient Preference Over CPAP: Despite CPAP being a widely accepted treatment, it requires a significant lifestyle change, and not all patients adapt well to it. For those who do not respond to or cannot tolerate CPAP therapy, the Inspire implant has been a preferable alternative. Reportedly, 96% of people say Inspire is better than the CPAP machine.
  • Reduction in Snoring: Snoring, a common symptom of OSA, can be a significant issue for both the patient and their sleep partners. It has been reported that more than 90% of people with the Inspire implant have partners who confirm the elimination of snoring at night.
  • High Patient Satisfaction: The Inspire system has been clinically proven to minimize sleep apnea events, has a high patient satisfaction rating, and has an impressive therapy adherence history. This indicates that patients find the Inspire implant effective in managing their condition and satisfactory in terms of usage and overall impact on their quality of life.

Finding an Inspire-Trained Provider

To find an Inspire provider in your area, visit the official Inspire website, which typically features a provider locator tool. This tool allows you to input your location details, such as city or zip code, to find a list of nearby healthcare providers who are trained and experienced in Inspire therapy. 

Additionally, it’s often beneficial to consult with your primary care physician or a sleep specialist, as they can refer you to a qualified provider in your region. They may also have insights into the best providers based on your specific medical needs and circumstances. Remember, choosing a provider with experience in administering Inspire therapy is crucial for the best treatment outcomes.

Visit the Inspire website here!

Find an Inspire Provider in your area!  

Kansas City
If you are in the Kansas City area, visit St Lukes for your inspiring consultation needs or call 816-347-5128.