People with obstructive sleep apnea who struggle to tolerate CPAP may soon have another treatment option available in the Florida Keys.
Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Dr. Rhoda Smith of Key West Surgical Group is working with a local ENT and sleep team to provide Inspire therapy, an implanted device designed to help keep the airway open during sleep.
“It’s a new procedure she’s going to be doing,” Sommer said. “She will be the surgeon that just implants the device. Like you said, we’re working with the local ENT who will monitor it.”
CPAP remains the standard first-line treatment for obstructive sleep apnea, but not everyone is able to tolerate the machine.
“CPAP is used for, as we talked about, obstructive sleep apnea,” she said. “There are a lot of people that have obstructive sleep apnea, but they cannot tolerate the CPAP machine.”
CPAP uses a mask and hose connected to a machine that provides positive airway pressure to prevent the airway from collapsing during sleep.
“CPAP has been around that long, and the majority of the time, people can tolerate it, but there are people that don’t,” Sommer said. “So it is still the first treatment out there to manage sleep apnea.”
She stressed that hearing about Inspire does not mean CPAP is ineffective.
“Just because we hear about Inspire doesn’t mean CPAP doesn’t work,” Sommer said. “Inspire is another treatment that a patient can have if they qualify if they’re unable to tolerate the CPAP well.”
Obstructive sleep apnea occurs when the upper airway repeatedly becomes narrow or completely closes while a person is sleeping.
“Sleeping apnea means the person has stopped breathing,” Sommer said. “So that’s either caused by an obstruction, or they have hypopnea,” which occurs when breathing is significantly reduced rather than completely stopped.
When an apnea or hypopnea event occurs, oxygen levels can drop and the brain briefly wakes the person to reopen the airway.
“Sometimes the person doesn’t remember waking up,” Sommer said. “A lot of times, their partner will be like, ‘Hey, you’re waking up,’ or ‘I hear you stop breathing when you’re sleeping.’”
People with sleep apnea may feel exhausted despite getting eight or 10 hours of sleep because their sleep is repeatedly interrupted.
Other symptoms can include loud snoring followed by gasping or choking, morning headaches, dry mouth, difficulty concentrating, irritability and excessive daytime sleepiness.
Untreated sleep apnea can also have broader health consequences.
“It can be associated with high blood pressure, atrial fibrillation, other cardiovascular problems, stroke, type 2 diabetes, increased risk of motor vehicle accidents,” Sommer said.
A sleep study is necessary to diagnose sleep apnea and determine its severity.
“If you’re having any of these symptoms, if you or your partner is telling you, ‘I think you’re not breathing in your sleep,’ you need to do a sleep study,” Sommer said.
Sleep apnea is generally classified using the apnea-hypopnea index, or AHI, which measures the average number of apnea and hypopnea events occurring during an hour of sleep.
An AHI of five to 15 is considered mild, 15 to 30 is moderate and more than 30 is considered severe.
Sleep studies can be performed at a local sleep laboratory, although some patients may also qualify for an at-home test.
When CPAP is not tolerated, Inspire may be an option for certain patients.
Inspire therapy uses hypoglossal nerve stimulation. The device is implanted under the skin in the chest, with wires extending to the hypoglossal nerve, which controls movement of the tongue.
“When we fall asleep, the muscles in our upper airway relax, and in people with sleep apnea, the tongue and the surrounding tissues sometimes fall back and cause that obstruction,” Sommer said. “Inspire is a small implanted device. It’s really tiny. It kind of is the same size of a pacemaker, and they run wires up to a clip that goes around your hypoglossal nerve, and that is going to stimulate to keep the tongue from falling back while you’re sleeping.”
Unlike CPAP, which uses air pressure from outside the body, Inspire stimulates the muscles from inside the body to help keep the airway open.
The device is activated with a small remote at bedtime. Sommer said there is a delay before the stimulation begins, allowing the patient time to fall asleep. The device is then turned off in the morning.
However, Inspire is not appropriate for everyone with sleep apnea.
Patients generally must have moderate to severe obstructive sleep apnea and either have difficulty using CPAP or not benefit adequately from it. Sommer said insurance providers can have different eligibility and coverage requirements.
Inspire is intended for obstructive sleep apnea, rather than central sleep apnea.
“There are some patients who have central sleep apnea,” Sommer said. “That’s different. That comes from the brain, so Inspire is not going to help to keep the airway open.”
The process begins with a sleep study and evaluation by an ENT and sleep team. Patients generally must first try CPAP, particularly because insurance providers, including Medicare, may require it as the first-line treatment.
“If that occurs, that you don’t tolerate it, or right now you have it and you’re not tolerating it, then yes, you can come and see Dr. Smith,” Sommer said.
Dr. Smith can then evaluate whether the patient is a candidate for Inspire, including examining the airway and the pattern of collapse.
“She goes in just like she does an endoscopy, and she assesses the tissue, the tongue, the upper palate, making sure that it’s what the pattern of collapse is,” Sommer said.
If the patient qualifies and receives approval for the device, Dr. Smith will perform the implantation surgery.
The procedure is performed on an outpatient basis and involves two small incisions.
“It can be done at the surgery center, just like they do pacemakers, but it’s not as much wires,” Sommer said. “It goes again under the skin, and they run the little wires up to the hypoglossal nerve.”
Following surgery, patients typically allow the area to heal for about four weeks before the device is activated and programmed by the ENT and sleep team.
Sommer said recovery is generally routine, although patients can experience some soreness, swelling and discomfort at the surgical sites.
She also emphasized that Inspire is a treatment, not a cure.
“There really is no cure for sleep apnea,” Sommer said. “It’s either, like we talked about, obstructive or central. If it comes from the brain, it’s something that occurs over time, so the most important thing is to see what type of sleep apnea you have.”
For people who cannot tolerate CPAP, however, Inspire could provide another option.
“If you haven’t been able to tolerate the CPAP machine, this could be an option for you,” Sommer said.
Several factors can influence sleep apnea, including weight, alcohol use, sedating medications, smoking and nasal obstruction caused by allergies or a deviated septum.
“Inspire doesn’t take those away,” Sommer said. “So it’s important to look at the overall picture when treating sleep apnea.”
The new Inspire service is part of an expanding range of medical services being offered through Key West Surgical Group and its partnership with local specialists. For more information, click here: https://www.keywestsurgicalgroup.com/