Good prospects for sleep apnea

Scientific study of the efficacy of a new treatment against breathing pauses during sleep provides encouraging results

The Ear, Nose and Throat Clinic, University Medical Center Mannheim (UMM) is involved in the introduction of a new system that could in future help snorers with apnea (obstructive sleep apnea, OSA) to a more restful sleep. This is a fully implantable pacemaker system which ensures by mild stimulation of the muscles of the upper airway that the patient is breathing evenly.

If the nightly snoring is accompanied by regular apnea, which is no longer just an issue between two people who share the nightly camp together, but then it comes to the health of the person concerned. Patients with obstructive sleep apnea wrestle overnight constantly for breath. The cause is the relaxation of the muscles, which causes the tongue falls into the throat during sleep and thereby narrows the airways or even closes.

What is unpleasant for the bed partner, the body of the snore heavily burdened: The pauses in breathing, the oxygen concentration decreases in the blood, stress hormones are released and triggered an arousal that opens the airway again and prevent suffocation. At deep, restful sleep is not to think, the consequences are tiredness, fatigue and lack of concentration during the day. The risk for heart attack, stroke and high blood pressure is increased.

The standard treatment of obstructive sleep apnea is a breathing system (Continuous Positive Airway Pressure, CPAP), which produces over a hose and a face mask an overpressure, whereby the airways are kept open during sleep. This so-called CPAP is effective, but is not accepted by many of those affected: Nearly Half of the patients is therefore not sufficient or not treated at all.

For these patients, Inc., developed the system now, the so-called Upper Airway Stimulation (UAS) therapy by means of Inspire Medical Systems, be a solution. It involves an implanted pacemaker which stimulates the hypoglossal nerve, and thus responsible for the pauses in breathing relaxation of muscles prevented directly.

The effectiveness of this system was tested in a study whose results have now been published in the prestigious journal "New England Journal of Medicine". An international study 15 clinics in the US and 7 clinics in Europe were involved. A key issue was the ENT Department of the University Medical Center Mannheim, which has the surgical technique first used in Germany and significantly optimized for the study.

The results of the study show that Inspire therapy not only significantly improves obstructive sleep apnea, namely in terms of breathing pauses (to 68 percent) and oxygen wastes in the blood (about 70 percent), but also the related quality of life and daytime sleepiness.

For patients with CPAP intolerance are the advantages of the system are obvious: Before going to sleep, stimulation is enabled, turn off after waking in the morning. Through the operation are no irreversible changes to the upper respiratory tract, swallowing and speaking are unaffected.

The therapy with the pacing system of Inspire Medical Systems has been certified and approved in Europe for use. End 2013 therapy at the University Hospital Mannheim was first refunded the first clinic in Germany by the health insurance.

published study

Upper Airway Stimulation for Obstructive Sleep Apnea Patrick J. Strollo, Jr., MD, Ryan J. Soose, MD, Joachim T. Maurer, MD, et al. New England Journal of Medicine 2014; 370: 139-149 January 9, 2014

DOI: 10.1056 / NEJMoa1308659

Source: Mannheim [UMM]