One of the most common questions I get asked by patients and my online community is, “What’s the newest or cutting edge option for treating obstructive sleep apnea?” Internally, I cringe at this question, since it’s like asking what’s the best way to get from your home to work? The answer is…it depends. You can walk, use a skateboard, cycle, drive a car, or even fly there by helicopter. Even the car answer can range from a basic Toyota subcompact to a Lamborghini. All these options have their pros and cons. Some are not very practical, such as flying by helicopter.
It’s understandable that people with obstructive sleep apnea are always looking for better ways of treating OSA, not having to use a pressurized mask (CPAP) for the rest of their lives. Others are reluctant to consider surgery, even when they are good candidates. There are also too many good dental options to choose from. All these mainstream treatment options work to various degrees with various pros and cons.
One recent option that’s been available to sleep apnea patients in the past few years is the tongue nerve pacemaker. The official term is called hypoglossal nerve stimulation, where a pacemaker-like device is implanted in the right upper chest wall, and an electrical cuff is placed around the nerve that protrudes your tongue (the hypoglossal nerve). A sensor lead is placed below the pacemaker device to detect breathing efforts. The device senses when you are making an effort to breathe, and creates an electrical signal to push your tongue forward, opening up your airway being the tongue and soft palate. Click here to see a graphic.
This sounds like a novel idea, but it was first described many years ago by Johns Hopkins researchers in the 1990s. It didn’t take hold for mass sleep apnea treatment until 3 start-up companies were created in the United States in 2006 years of 2007. ImThera is being used in Europe and is currently in clinical trials in the United States. Inspire and Apnex performed clinical studies in the early 2010s. I had the privilege of being involved in the early studies with Apnex.
Inspire received FDA approval in 2014. In their landmark New England Journal of Medicine publication, they found that in the 126 patient study, the average AHI at 12 months dropped from 29.3 to 9.0, a 68% difference. The overall response rate (> 50% drop in AHI and final AHI < 20) was 66%. The Epworth Sleepiness Score dropped from 11.6 to 7 (< 10 is considered normal). Functional Outcome of Sleep Questionnaire (FOSQ) scores increased from 14.3 …