Upper-Airway Stimulation for OSA

PST · Post by **PST** » Fri Jan 10, 2014 1:11 pm

There is an interesting study in the New England Journal of Medicine today about a treatment for obstructive sleep apnea. It is behind a pay wall, so the citation is just to a summary. There is more information about the study in the New York Times. The treatment involves electrical stimulation of tissues in the airway to keep them open. It is said to be for people who cannot or will not tolerate CPAP rather than a substitute for CPAP. The Times assumes that most of its readers don't know what AHI is, but when you get to the part of the story that mentions breathing pauses, it means AHI. It looks like it might be an okay treatment for a subset of the OSA community.

Sir NoddinOff · Post by **Sir NoddinOff** » Fri Jan 10, 2014 1:14 pm

Always great to hear of new research. Maybe some day we can leave the blower and mask behind.

Sludge · Post by **Sludge** » Sat Jan 11, 2014 3:40 am

Search HGNS:

search.php?keywords=hgns

Christine L · Post by **Christine L** » Sat Jan 11, 2014 8:03 am

It is behind a pay wall, so the citation is just to a summary

I found a five-year old thread with a long discussion including charts and some good laughs - viewtopic.php?f=1&t=39245&st=0&sk=t&sd=a

Not something I would be interested in. Will stick with CPAP.

penuel · Post by **penuel** » Sat Jan 11, 2014 6:27 pm

It works like this (not what PST wrote above that "The treatment involves electrical stimulation of tissues in the airway to keep them open." ):

"When an electrode is placed in the hypoglossal nerve the tongue is stimulated to actually protrude and that in essence offsets upper airway closure during sleep," Dr. Strollo explained. "The implantation takes place, and the patient is subsequently brought into the sleep laboratory where the pacemaker is adjusted to the appropriate setting to allow airway opening during sleep."

Lots of noise but not convincing:

http://www.nejm.org/doi/full/10.1056/NE ... articleTop

JohnO · Post by **JohnO** » Sat Jan 11, 2014 6:44 pm

penuel wrote:
It works like this:

"When an electrode is placed in the hypoglossal nerve the tongue is stimulated to actually protrude and that in essence offsets upper airway closure during sleep," Dr. Strollo explained.

All I can say is -- I'm glad CPAP is effective for me! I'm very happy to see new therapies that might help others, though.

hyperlexis · Post by **hyperlexis** » Sat Jan 11, 2014 6:55 pm

I just read the article in the NYT. Fascinating development.

While I personally may not choose to go that route I have a good friend who has terrible apnea but absolutely refuses to use CPAP for multiple reasons. I will pass this therapy info along to him.

penuel · Post by **penuel** » Sat Jan 11, 2014 8:51 pm

hyperlexis wrote:I just read the article in the NYT. Fascinating development.

While I personally may not choose to go that route I have a good friend who has terrible apnea but absolutely refuses to use CPAP for multiple reasons. I will pass this therapy info along to him.

Comment,

About your friend, notice that the mentioned Upper Airway Stimulation surgically implanted device was selected only for certain OSA sufferers:

"Participants

Participants with moderate-to-severe obstructive sleep apnea were eligible for enrollment if they had difficulty accepting or adhering to CPAP treatment. Exclusion criteria were a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of more than 32.0, neuromuscular disease, hypoglossal-nerve palsy, severe restrictive or obstructive pulmonary disease, moderate-to-severe pulmonary arterial hypertension, severe valvular heart disease, New York Heart Association class III or IV heart failure, recent myocardial infarction or severe cardiac arrhythmias (within the past 6 months), persistent uncontrolled hypertension despite medication use, active psychiatric disease, and coexisting nonrespiratory sleep disorders that would confound functional sleep assessment."

49er · Post by **49er** » Sun Jan 12, 2014 8:28 am

I posted this in another thread but it bears repeating.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645251/

There is emerging evidence that increased nasal resistance affects CPAP use and initial acceptance of this treatment (37–39). Using acoustic rhinometry to measure the internal dimensions of the airway, those patients with smaller nasal cross-sectional area and reduced volume were much less likely to be adherent (37). Age-adjusted minimum cross-sectional area explained 22% of the variance in CPAP adherence (37). Interestingly, self-reported nasal stuffiness was not associated with nasal dimensions. Nasal resistance/obstruction also seems to influence the initial acceptance of CPAP treatment, with increased nasal pressure resulting in a 50% greater chance of rejecting CPAP as a treatment (38, 39). Acceptance of CPAP was improved with nasal surgery, suggesting that the nasal cavity should be thoroughly evaluated before treatment, and surgery initiated for patients presenting with either total nasal resistance of more than 0.38 mm Hg/cm3 per second, nasal obstruction that would not be decreased with medical treatment, nasal septum deviation, or inferior turbinate hypertrophy.

I feel this is definitely true in my situation and is why I am seeing a 2nd ENT for an opinion on Tuesday about having surgery. I have been told I have narrow airways which include the nasal area.

Sorry, I know I am getting off topic but I wonder how many folks who had this invasive procedure were evaluated for this initially? I don't know, it just seems like common sense to check this out but then again, what do I know?

49er

ChicagoGranny · Post by **ChicagoGranny** » Sun Jan 12, 2014 2:36 pm

49er wrote: what do I know?

49er

-it-all?

49er · Post by **49er** » Sun Jan 12, 2014 3:02 pm

ChicagoGranny wrote:
49er wrote: what do I know?

49er
-it-all?

You never miss an opportunity to take a shot at me CG, do you ? Real classy.

49er

Sludge · Post by **Sludge** » Sun Jan 12, 2014 4:25 pm

Did you see this on the news feed?

CNN (January 12, 2014) -- Earlier today it was reported that a hypoglossal nerve stimulation (HGNS) device that had been surgically implanted in a patient at the East Central Memorial Hospital for Special Care catastrophically malfunctioned when dilithium crystal batteries were inadvertently substituted for standard lithium. The results of the error were recorded by a photographer at the scene:

[/quote]

ChicagoGranny · Post by **ChicagoGranny** » Sun Jan 12, 2014 4:38 pm

49er wrote:
You never miss an opportunity to take a shot at me CG, do you ?

49er

0.1%

Showing great restraint.

49er · Post by **49er** » Sun Jan 12, 2014 4:47 pm

ChicagoGranny wrote:
49er wrote:
You never miss an opportunity to take a shot at me CG, do you ?

49er
0.1%

Showing great restraint.

Wrong CG, a person who truly shows great restraint doesn't keep taking unprovoked shots at someone.

49er

Upper-Airway Stimulation for OSA

Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Re: Upper-Airway Stimulation for OSA

Humidifier

Additional Comments: CareFusion chinstrap. Quite stiff and not smooth. Not for delicate faces.