Implant Device a New Option for Sleep Apnea Sufferers


 
Kirk Withrow, MD
You are asleep and you stop breathing. It takes a while--anywhere from seconds to a minute or more--for your body to notice the buildup of carbon dioxide and for the chemoreceptors in the bloodstream to send a signal to your brain to wake up and breathe.

It's called sleep apnea. And though it sounds alarming, the process can happen several times an hour. More than seven million Americans suffer from it, and the figure is thought to be higher because many more people aren't aware they have it.

The traditional therapy for apnea since the late 1980s has been a machine called a CPAP (Continuous Positive Airway Pressure), a facial mask that applies mild air pressure mixed with oxygen from a connected tank to keep the airways open during sleep.

But studies show that about half of CPAP patients, for whatever reason, stop using the therapy. Compliance is an issue according to Kirk Withrow, MD, assistant professor of otolaryngology at UAB. "For patients who do tolerate CPAP, it can be life-changing for them and they do extremely well. One reason many people stop using CPAP is that they report they wake up and the mask is on the floor," he says. "Some others are claustrophobic."    

Now there's a new implantable device that stimulates breathing from within the body. It's called upper airway stimulation, and Withrow says the therapy has several advantages over CPAP. "The device looks like a pacemaker in its size and design," he says. “It detects breathing when the chest expands, and when breathing is interrupted a signal goes to the generator, which sends a signal to the electrode at the cranial nerve that helps with tongue movement.

"When that nerve receives a stimulus, it not only gives muscle tone to the tongue, but it also stiffens the upper portions of the throat. It doesn't do anything when the patient is not sleeping, because they have a remote control they can set and turn on the device when they go to sleep and turn it off when they wake up."

The surgery involves only three small incisions, and patients usually go home the same day. "One incision is under the armpit, basically over the ribs,” Withrow says. “We put the generator on the right, whereas pacemakers are generally on the left." Another incision is at the jawline of the neck, and the third is for the breathing sensor below the generator.

"The gold standard for detecting apnea is a sleep study," Withrow says, "but we also do a sedated exam with a scope to look in the back of the nose and see how the airway collapses."

Previous options ranged from simple solutions, like using a mouthpiece to reduce snoring, all the way to serious surgeries. "The biggest category is soft-tissue surgery which involves taking out the tonsils or changing how the muscles in the tissue of the throat work," Withrow says. "The other category involves the bones, and consists of moving the jaw forward. You can tell by the description that those are painful surgeries, and while they can be effective, there's a high morbidity rate, and they're not as predictable. On the other hand, this new procedure doesn't change anything in the throat, so swallowing and the sense of taste is exactly as it was before."    

Untreated sleep apnea can have far-reaching effects. "In the short term, the effects are feeling tired, decreased productivity, snoring that's disrupting to the spouse or other people in the household, and relationship issues from poor sleep and poor quality of life,” Withrow says. “There's an increased risk of automobile accidents related to being sleepy and not performing optimally on psychomotor tasks and reaction speed when driving a car."    

In the long term, the stress that apnea puts on the heart and lungs can raise the risk of high blood pressure, heart attacks, strokes and--at very high severity levels--early death.

"This new therapy has great benefits," Withrow says, "and it has a significant ability to pick up a fair number of patients who otherwise would just go untreated. For them, the difference can be like night and day."

 

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Photo: Kirk Withrow, MD

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