The CPAP machine, the go-to treatment for obstructive sleep apnea for close to 40 years, started as a concoction by Australian professor Colin Sullivan in 1980 that combined a paint compressor attached to pool tubing and a plaster-cast mask glued to the patient’s face.
Hartford Hospital in early 2016 became one of the first hospitals in the Northeast to offer patients a new technology potentially as significant as CPAP — a mask that blows air into the nose and throat, preventing obstruction — though lacking in paint-compressor charm. Instead, the pacemaker appears to be the logical inspiration for the Inspire hypoglossal nerve stimulator, a small implantable device that gently stimulates the nerve that controls the tongue to prevent an obstruction.
“We see a significant improvement in the overall severity of sleep apnea,” says Dr. Carl Moeller, an ear, nose, and throat specialist at Hartford Hospital, “with a 78 percent reduction in the number of obstructive events per hour, even three years after implantation. Additionally, 80 percent of implant patients’ bed partners reports soft or no snoring three years following surgery.”
In a minimally invasive outpatient procedure, a surgeon implants a small pulse generator just under the skin on right chest. The generator also includes a stimulation lead placed in the neck and a breathing sensor on the side of ribs. The patient controls the device with a small handheld remote, activating the therapy before bedtime. It turns off automatically the next morning.
It’s not for everyone. Patients must have an apnea-hypopnea index (AHI) between 20 and 65. The device manufacturer also recommends that patients should have a BMI of 32 or below.
An ear, nose and throat specialist will also assess the type of obstructive collapse under a quick sedated endoscopy. Only those with an anteroposterior collapse at the level of the soft palate are eligible. Patients with concentric collapse of the soft palate cannot receive the Inspire therapy.
“Patients typically go home the same day or next day following surgery,” says Dr. Moeller. “Pain is usually mild and the patient may return to normal activity after a few days.”
For more information, visit Hartford HealthCare’s Neuroscience Institute.