By Vaishnavi Challapalli Sri, MD, DABSM
Obstructive sleep apnea is associated with significant health risks. Moderate to severe cases are an independent risk factor for insulin resistance, dyslipidemia, vascular disease and death.
The effectiveness of continuous positive airway pressure (CPAP) therapy is dependent on patient acceptance and adherence to treatment. Most patients’ opinion is that CPAP is inconvenient and esthetically not pleasing.
Inspire, a novel FDA-approved implantable upper airway stimulation device, is an alternate therapy. Relatively recent as an option in Hampton Roads, it is a hypoglossal nerve stimulator that prevents airway obstructions during sleep.
The device has a programmable, MRI-compatible neuro-stimulator located in the chest, a pressure sensing lead that detects patient’s breathing, and a stimulator lead that delivers mild stimulation to the hypoglossal/tongue nerve.
The stimulator is controlled by a patient’s handheld remote control. Patients turn on the device before going to bed to gently stimulate the tongue muscles while sleeping and then turn it off in the morning.
Inspire is implanted under general anesthesia by a two-incision approach, one on the chest and the other on the neck on the right side of the patient’s body. Data has shown a 68 percent reduction in apnea hypopnea index after 12 months.
Similar to a pacemaker, the device’s battery pack lasts seven to 10 years. A month after implantation, the device is activated followed by a post-operative sleep study to assure proper stimulation. The incidence of serious implant-related complications is less than two percent. Bruising and tingling along the tongue are usually temporary and resolve within weeks.
Inspire is covered by most insurances, including Anthem, Aetna, Blue Cross Blue Shield, United, Cigna, Medicare and Tricare.
Hypoglossal nerve stimulation is medically necessary when the following criteria are met:
• Adults > 22 years with moderate and severe obstructive sleep apnea
• Central apnea makeup < 25% of total apnea index
• BMI of < 32 or < 35
• Absence of complete concentric collapse at soft palate level during drug-induced sleep endoscopy (DISE)
• Failure of CPAP therapy due to claustrophobia or intolerance to CPAP
CPAP and other PAP therapy remain the first line of treatment of moderate to severe obstructive sleep apnea; however, the Inspire system is a great alternative for patients who meet the above conditions. My first patient to have the device implanted this past spring has had very positive results.
I encourage all physicians to discuss the significance of adequate sleep with their patients. People who habitually sleep less than six hours are at significantly higher risk for insulin resistance, cancers, myocardial infarctions and motor vehicle accidents. In addition, contrary to popular belief, snoring is not always normal.
As sleep specialists, my partners and I are dedicated to treating sleep disorders, as improving sleep improves both health and quality of life.
Dr. Challapalli Sri is a board certified Sleep Medicine specialist with Sleep Specialists of Tidewater, a Bayview Physicians Group practice. She is based at Lakeview Medical Center in Suffolk and Hague Medical Associates in Norfolk. bayviewphysicians.com