Obstructive Sleep Apnea Treatment With a Nerve Stimulator

Back in January of 2011, I posted about a device developed to treat obstructive sleep apnea (OSA) that could potentially replace CPAP. It's an implantable stimulator that causes the tongue to thrust forward, preventing it from collapsing backwards and blocking off the throat.

In the November edition of the Journal Sleep, Dr. Eastwood and others did a study on 21 patients with moderate to severe OSA that had failed CPAP therapy. They monitored the patients for 6 months and had repeat sleep studies to determine its effectiveness. The results showed that the nerve stimulator did decrease OSA severity and daytime sleepiness. It also improved some aspects of their sleep architecture and daytime functioning. Adherence to the device was high and it was felt to be safe with a low complication rate.

When looking at the details, the device reduced the OSA severity by 55% - from an average AHI of 43.1 to 19.5 at 6 months. But an AHI of 19.5 is considered to be a moderate amount of OSA, with 5 or less being ideal. Also, the device worked better in patients that were thinner than those that were heavier, which makes anatomical sense.

This was a small study with no control group. It will be interesting to see the results from larger trials and for a longer follow up period. One day, this device could be a good alternative to those who have failed CPAP therapy.

Tongue Zapper

There is an article in the local paper about a new way to treat obstructive sleep apnea (OSA). Researchers are working on an implantable device that would send electrical signals to the nerve that controls the tongue. Tongue collapse onto the back of the throat can contribute to airway closure and OSA. By stimulating the tongue nerve (called the hypoglossal nerve) with electrical impulses, the tongue can be forced to contract, and consequently staying away from the back of the throat during sleep.

The article mentions three companies working on this implantable device. Inspire Medical Systems is planning to enroll 100 OSA patients in a study in the U.S. and Europe to see if the hypoglossal nerve stimulation works. ImThera Medical says it hopes to begin U.S. studies later next year, and Apnex Medical, has announced testing.

This type of treatment is exciting to me, as it could be used as a stand-alone therapy, replacing CPAP in some patients. It also might be part of a combination therapy with an oral applliance and/or upper airway surgery.