Poll - Which OSA treatment would you try?

[sydneybird]

The electrical stimulators are currently in clinical trials, stent just hitting the market in Europe, and Pillars has been out for about 3 years. Which ones would you try if CPAP is just not your thing. Which do you think will be around 10 years from now? Will any replace CPAP as a primary therapy?

Consider this: The following are cost estimates only for the devices, not for the pre and post care. CPAP costs about $2500 plus $800/yr for consumables; Pillar procedure costs about $3000; Electrical stimulation is said to cost $5000 for the stimulator and $20,000 for the surgical operation; I have no cost data for the removable stent.

Pillar System - http://www.pillarprocedure.com
Electro-Stimulation of the Hypoglosal Nerve - http://video.au.msn.com/watch/video/hop ... b5b4a6392d, http://www.apnexmedical.com , others
Removable Stent - http://www.alaxo.com/alaxostent_eng.html

[jbn3boys]

I think I'll stick to my machine! I'm not sure I like any of those options for me personally! I avoid surgery whenever possible. (I could have surgery to correct my hearth arrhythmia, but choose to stay on meds instead.) And I just can't even imagine shoving something up my nose and down my throat. Ewww. (sorry, personal issues...I can't even handle using a nasal wash.)

[sydneybird]

Just added "none of these" as a choice.

[Kahfree]

So I responded and my response did not post.

Here it is again, but now I am informed as I have read up on and watched some videos.

If I had to choose, and I might ask my doctor about it, but I would choose the Pillar Procedure.

I would assume that the procedure would still mean using the cpap for the first 8-12 weeks while the implants are built up by the body. However, if it does work, then its great. It looks simple enough to do. It is approved by the FDA and Medicare. If used for snoring alone, it is not covered by Insurance, but some insurance companies do cover the cost of it if the diagnosis is OSA. I would have to check to see if my insurance covers it, as I am sure its somewhat expensive. I would first like to see a sleep study on a person who had the procedure and then retested after the implants to compare and evaluate his/her AHI rates post and pre implant.

I have an open mind and feel that medical technology is always changing They are always finding new ways to help or cure people of diseases. Many things used years ago are now obsolete in the practice of medicine because of new less invasive finds. I am sure that most people who are OSA would love to be free of the machine they are hooked up to for life. I know I would!

[sydneybird]

I just saw this tread regarding the Pillar system viewtopic/t38268/Pillar-procedure-effectiveness.html

[sydneybird]

Sorry to keep responding to my own Poll, but I have some more info about the electrical stimulators under development that you may not know about. There are about 4 or 5 start-up medical device companies looking into this technology. Apparently Medtronic engineers invented the basic technology for use to treat sleep apnea more than 20 years ago but it didn't go anywhere. So the patent has expired and these other companies are jumping all over it and Medtronic is back working the technology as well, along with marketing their Pillar system.

http://www.cardiacconcepts.com/respiacardia Cardiac Concepts has the RespiCardia System targeting central apnea, where you stop breathing just for the heck of it. An optical sensor detects respiration and an electrode stimulates the phrenic nerve to restore breathing.

The others are directed to OSA with sensing electrodes sensing different physiological events so that the device can shock the hypoglossal nerve to get your tongue and soft tissue from blocking the airway.
http://www.inspiresleep.com Inspire detects your body's attempt to breath using an implanted pressure sensor to detect respiration.
http://www.apnexmedical.com The Apnex device is similar to Inspire but it uses two sensing electrodes that use bio-impedance to detect respiration.

Much money is being invested into these technologies, so keep an eye out.

Contact the companies if you want to be part of their clinical trials and let us know how it is working for you.

[snnnark]

If I had to, the stent does seem like the best option. But it wouldn't help the centrals.

[ResmedUser]

I am skeptical that any of these really work all that well. The gold standard treatments for OSA in evidence based medicine are 1) CPAP and 2) weight loss, if weight loss is needed...which it usually is.

Mikey

[robysue]

I am skeptical that any of these really work all that well. The gold standard treatments for OSA in evidence based medicine are 1) CPAP and 2) weight loss, if weight loss is needed...which it usually is.

Mikey

Mikey,

According to my sleep doctor's PA some 40% of sleep apnea patients are NORMAL weight or UNDERWEIGHT. I'm one of them.

And of the 60% of apnea patients who are overweight, the vast majority of them will NOT be able cure their apnea even if they did lose ALL their excess weight. Why? Most OSA is caused by structural problems in the throat. In many (not all, but many) of the overweight apnea patients the connection between the apnea and the weight is far more subtle than your statement implies: For many overweight patients with OSA, the OSA lead to metabolic changes which lead to weight gain in the first place or which made it all but impossible to lose the weight until and unless the OSA is properly treated by CPAP (or an oral device---if the apnea is mild). The additional weight clearly stresses an already compromised upper airway system and may increase the severity of the apnea. But it seldom actually is the sole cause of OSA.

A lucky few overweight OSA patients are able to lose weight while NOT treating their apnea by CPAP and eliminate the apnea by weight loss alone. But they are very few and very far between.

A few more lucky overweight OSA patients are able to lose weight while ON CPAP and subsequently manage to demonstrate through a PSG that they no longer need CPAP therapy. But these people are also few and far between.

The vast majority of overweight OSA patients who manage to lose all their excess weight do NOT manage to free themselves of apnea. And they continue to need CPAP to properly treat their apnea. In many cases, the pressure needed to keep the airway does go down with weight loss, but even here it is an individual thing: Some folks find they need a pressure INCREASE after losing weight in order to keep the apnea under control.

SO: Please do NOT promulgate the myth that weight loss is a gold standard treatment for OSA. It most certainly is not. The ONLY gold standard treatment at present is xPAP therapy.

And please do NOT promulgate the myth that MOST OSA patients could cure ---or even substantially improve--- their sleep apnea by losing weight. First of all that completely ignores the 40% of us who do NOT need to lose weight. And second of all, it sends a message that the other 60% are somehow responsible for creating their problem by being overweight. And nothing could be farther from the truth.

[rosiefrosie]

I think I will go hug my machine! Most of these sound too painful in more ways than one.

rosie

[JayC]

None of the above.....

I have some funky thing going on with my brain electrically (every eeg shows abnormal activity), so not liking the idea of adding electrical devices to that!

According to my last sleep study, I breathe shallowly and/or slowly (so hypopneas ARE my major issue, and not just scored as such by my ResMed!). Not sure how a stent addresses hypopneas that do not appear to have an obstructive element most of the time.

My APAP is helping; and as I augment with other therapies to deal with other sleep issues, I am feeling slowly more improved.........

Being tethered to electricity is a down-side for some things I would like to do.....I will figure a way to do them AND get good sleep.....even if I have to carry battery and machine with me. Small price to pay for not having the dull "hangover" heacache almost every morning since I was in my early teens at least.

J

[lbw]

I'll stick with CPAP. All those options seem really invasive and painful

[Julie]

I would try the elect. stim. if only because I've seen it work in other far more serious applications (like breathing in paraplegia) - years and years ago. It's not a new idea, even if it's new here, and can make a big difference to letting people function.

[Cindy Lou Who]

I'll stick with my APAP for now, thank you. However[/b] that Alaxostent looks interesting. Don't think I would have trouble putting it in place, but wonder how it is removed once deployed? Can a person talk while it's installed? That would be the one and only reason that I couldn't use it.
And yes, I didn't watch the video: my computer is too slow tonight.
Cindy

[sydneybird]

I'll stick with my APAP for now, thank you. However[/b] that Alaxostent looks interesting. Don't think I would have trouble putting it in place, but wonder how it is removed once deployed? Can a person talk while it's installed? That would be the one and only reason that I couldn't use it.
And yes, I didn't watch the video: my computer is too slow tonight.
Cindy

You can just yank it back out in the morning. It is so flexible I would think once you lay down that the soft tissue would just squish it flat. Maybe a good way to clean out your sinuses. In the video you can see it going down the back of the throat in a mouth shot. Very creepy.