Treatments beyond CPAP for OSA

Dear Dr. Roach: Can you share as much information as you know about a procedure called Inspire that supposedly helps reduce the serious issues of sleep apnea?

What are the benefits, and how does it work? What are the risks?

Inspire has been recommended for me at age 77 because I have tried CPAP machines twice without success. A home test and sleep lab test revealed that my brain awoke 56 times in an hour. My fear of Inspire has to do with the motor and wiring inmy body.— J.H.

Obstructive sleep apnea is a common, underdiagnosed sleep issue. In a person with OSA, the soft tissues in the neck and throat close the airway when the muscles are relaxed during sleep. This prevents breathing until a person wakes up for a second or two, the muscles regain tension and the person can take a breath. This can happen many times per night.

Without treatment, there can indeed be long-term damage to the heart and lungs. Standard treatment is continuous positive airway pressure, using a tight-fittingmaskto use air to keep the airway open. Being overweight or obese is a major risk factor, but some people have anatomy that predisposes to OSA.

The Inspire is not a motor. It is much more similar to a cardiac pacemaker. It senses the breathing with a sensing lead near the muscles of the ribs, and causes a movement of the tongue by stimulating the hypoglossal nerve. A seminal paper in 2014 showed that the device reduced the number of apnea events from 29 an hour to 9. Longer-term studies since then have confirmed.

It is important to recognize that there are alternatives available. In my opinion, there is now enough evidence that this treatment is effective, and can be offered as an option for carefully selected patients.