A Tongue Pacemaker for Sleep Apnea: High Tech Hope or Hype?

Originally at: https://doctorstevenpark.com/a-tongue-pacemaker-for-sleep-apnea-high-tech-hope-or-hype?utm_source=rss&utm_medium=rss&utm_campaign=a-tongue-pacemaker-for-sleep-apnea-high-tech-hope-or-hype

Every few years, a revolutionary way of treating OSA comes out. Nineteen eighty (1981) was a pivotal year in sleep medicine when Dr. Colin Sullivan reported reversing a vacuum cleaner motor to provide positive pressure through a makeshift mask to treat severe obstructive sleep apnea. Dr. Shiro Fujita also described a palatal operation to treat obstructive sleep apnea in 1981. Later on, oral appliances were also introduced. Over the years, advances were made with positive air pressure as well as with multi-level soft tissue and jaw procedures.

In 2014, the Inspire hypoglossal nerve stimulation procedure received FDA approval for patients in the United States. In their pivotal trial with results published in the New England Journal of Medicine in 2014, they reported a 68% drop in the average apnea hypopnea index (AHI), 70% drop in the oxygen desaturation index (ODI), and with an overall “response” rate of 66% (more than 50% drop in the AHI and less than 20).

Having been involved years prior with similar technology through another company called Apnex, I was pleased to see that this technology had progressed to the point of being available to the general public. Due to the volatile nature of medical high-tech start-up companies, I was cautiously waiting to see how they would do and see what the results would show in the real world on a long term basis. In 2018, a  group of surgeons performing this procedure published their 5 year outcomes. One hundred and twenty six patients were followed for 5 years, and 97 were included in the study, with 71 available sleep studies. Comparing from baseline to 12, 36 and 60 months, improvements across all measurements remained stable. The pre-treatment AHI was 32, dropping to 15, 11 and 12, at 12, 36 and 60 months, respectively. The functional outcome of sleep questionnaire (FOSQ, a validated sleep quality of life tool) increased significantly from 14 to 17, 17 and 18. The Epworth Sleepiness Scale dropped from 11.6 to 7 at all follow-up periods. Now, this procedure is being performed at over 300 centers in the United States and more and more insurance carriers are covering it, usually after a preauthorization process.

Technically, the pacemaker is implanted under the skin beneath the right collarbone, as opposed to a heart pacemaker, which is implanted on the left side. It’s a similar sized container. A small incision is made under the right chin, and the nerve that supplies the tongue (hypoglossal nerve) is exposed. This technique is very similar to a common procedure we perform in our field to remove the submandibular gland for stones, infections, or cancer. …

Sleep Talk: Episode 51 – Sleep in Teenagers

Originally at: https://sleephub.com.au/podcast-51/

Episode 51: Sleep in Teenagers

Why do teenagers have trouble with sleep? What can be done about it? To help answer these questions we talk with Assoc Prof Margot Davey, Director of the Melbourne Children’s Sleep Centre at Monash Children’s Hospital.

Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk – Talking all things sleep.

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Audio Timeline / Chapters:

  • 00:00 – 01:50 Introduction
  • 01:50 – 21:10 Theme – Sleep in Teenagers
  • 21:10 – 23:13 Clinical Tip
  • 23:13 – 26:57 Pick of the Month
  • 26:57 – 28:34 What’s Coming Up?

Next episode: Medication in Pregnancy

Links mentioned in the podcast: 

Presenters:

Guest interviews:

Margot DaveyAssoc Prof Margot Daveyis Director of the Melbourne Children’s Sleep Centre, Monash Children’s Hospital.  Margot is also an adjunct senior lecturer in the Ritchie Centre, Monash Institute of Medical Research, Monash University.  Her clinical practice is paediatric sleep medicine, and she works in public and private settings (Epworth Sleep Centre). Since 2006, Margot has been a chief investigator on numerous successful National Health and Medical Research Council (NHMRC) grants and an associate investigator on others. She has numerous peer-reviewed publications.

 

Regular hosts:

Dr Moira JungeDr Moira Junge is a health psychologist working in the sleep field, who has considerable experience working with people with sleeping difficulties in a multidisciplinary practice using a team-based approach. Moira is actively involved with the Australasian Sleep Association (ASA) and a board member of the Sleep Health Foundation. She has presented numerous workshops for psychologists and is involved with Monash University with teaching and supervision commitments. She is one of the founders and clinic directors at Yarraville Health Group which was established in 1998. In addition to her expertise in sleep disorders, her other areas of interest and expertise include smoking cessation, psychological adjustment to chronic illness, and grief and loss issues.

 

Dr David CunningtonDr David Cunnington is a sleep physician and director of Melbourne Sleep Disorders Centre, and co-founder and contributor to SleepHub. David trained in sleep medicine both in Australia and in the United States, at Harvard Medical School, and is certified as both an International Sleep Medicine Specialist and International Behavioural Sleep Medicine Specialist. David’s clinical practice …