INSPIRE is a new therapy for Sleep Apnea.
CPAP and Oral Appliances have been the first line treatments for mild to moderate sleep apnea and CPAP is the gold standard for severe sleep apnea.
While CPAP is extremely effective only 25% of patients actually utilize t as prescribed and 60% of patients refuse or fail CPAP completely.
Oral Appliances have been the choice of most patients who do not tolerate CPAP but these new studies show that there is a new effective treatment. Studies have shown that over 90% of patients offered a choice of CPAP or an Oral Appliance chose the Oral Appliance therapy. Chicago testimonials for Oral Appliance Therapy can be found at: https://thinkbetterlife.com/category/blogs/
Now that there is a new player and patients have more choices, a very positive development.
Morbidly obese patients are probably still going to need CPAP but just as oral appliances are used with CPAP to lower pressure cotreatment with inspire will probably be possible as well.
Inspire or Hypoglossal nerve stimulation (HNS) therapy is the newest player on the block.
There are three new studies (abstracts below) on the use of Upper Airway Stimulation with the Inspire device. This is GOD NEWS for patients who HATE CPAP!
North Shore Health System is the first in Chicago to offer Inspire Therapy.
https://www.northshore.org/sleep-center/procedures/inspire-therapy/
While there are risks associated with this therapy, they are low and the risks of untreated sleep apnea are much greater.
Conclusions in Upper Airway Stimulation for Obstructive Sleep Apnea: 5- Year Outcomes. showed Improvements in sleepiness, quality of life, and respiratory outcomes are observed with 5 years of UAS. Serious adverse events are uncommon. UAS is a nonanatomic surgical treatment with long-term benefit for individuals with moderate to severe OSA who have failed nasal continuous positive airway pressure. The study showed the responder rate was 63% at 5 years and that there was a 6% rate of serious device-related events related to lead/device adjustments.
The study in Am J Otolaryngol. 2018 Mar 2. pii: S0196-0709(18)30077-2. doi: 10.1016/j.amjoto.2018.03.003. "Uvulopalatopharyngoplasty vs CN XII stimulation for treatment of obstructive sleep apnea: A single institution experience. tShowed that Inspire was more successful than traditional UP3 surgery with 65% HNS patients achieving an AHI of under 5 ie HNS is "curative" in the majority of patients. "For select patients, HNS therapy provides excellent objective improvement in outcome measures."
Otolaryngol Head Neck Surg. 2018 Mar 1:194599818762383. doi: 10.1177/0194599818762383. [Epub ahead of print]
Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes.
Woodson BT1, Strohl KP2, Soose RJ3, Gillespie MB4, Maurer JT5, de Vries N6,7, Padhya TA8, Badr MS9, Lin HS10, Vanderveken OM7, Mickelson S11, Strollo PJ Jr12.
Abstract
Objective To present 5-year outcomes from a prospective cohort of patients with obstructive sleep apnea (OSA) who were treated with upper airway stimulation (UAS) via a unilateral hypoglossal nerve implant. Study Design A multicenter prospective cohort study. Setting Industry-supported multicenter academic and clinical trial. Methods From a cohort of 126 patients, 97 completed protocol, and 71 consented to a voluntary polysomnogram. Those having continuous positive airway pressure failure with moderate to severe OSA, body mass index <32 kg="" m="" span="" style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">2
KEYWORDS:
cranial nerve; device; device apnea hypopnea index; hypoglossal nerve; implant; long term; obstructive sleep apnea; polysomnogram; quality of life; sleep; sleepiness; surgery; upper airway stimulation
- PMID:
- 29582703
- DOI:
- 10.1177/0194599818762383
Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry.
Boon M, et al. Otolaryngol Head Neck Surg. 2018.
Abstract
Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients' symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.
