Inspire Surgical Treatment of Sleep Apnea

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If you have obstructive sleep apnea syndrome , you may be interested in exploring surgical options. One such option is the Inspire hypoglossal nerve stimulator. What is Inspire? Who should consider its use and what are the side effects? Find out more about the Inspire Upper Airway Stimulator and whether it might be right for you.

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Indications for the placement of Inspire

The Inspire stimulator is a surgically implanted device that activates the hypoglossal nerve to tighten the muscles of the tongue and upper airway during sleep, improve airflow, and reduce sleep apnea. It is approved for use by people with:

  • Moderate to severe obstructive sleep apnea with apnea-hypopnea index (AHI) greater than 15
  • Failure to comply with continuous positive air pressure ( CPAP ) therapy after the exam
  • Body mass index (BMI) less than 32, excluding individuals with morbid obesity

Contraindications

There are also several relative contraindications to Inspire therapy. If a sleep apnea-promoting obstruction occurs within the nose due to allergies or a deviated nasal septum , it will not be effective. Also, certain skeletal anatomy (such as a small or sunken jaw ) may be a reason for refusing treatment.

If the tonsils are enlarged, surgery on these tissues may be more appropriate. Certain neuromuscular conditions that affect the ability to swallow or contribute to slurred speech may also be a contraindication.

If frequent magnetic resonance imaging (MRI) is needed for other medical conditions, it is not safe to use the device for those exams. The treatment is not approved for use in children.

Most people who have had Inspire surgery have moderate to severe sleep apnea, and despite their best efforts, CPAP therapy has not been successful. They still have symptoms and may desperately need an effective solution. Surgery may be attractive as a more reliable solution to a problem that will not go away otherwise.

Questions to ask your sleep surgeon

It is important to fully understand the role of this treatment in your condition. The first option for the treatment of obstructive sleep apnea is the use of continuous positive airway pressure (CPAP). Successful treatment requires proper mask fit and optimal device configuration.

In some cases, alternatives such as weight loss, bi-level therapy , the use of oral appliances , or positional therapy can be used. In some cases, nothing seems to work.

Once you've exhausted your treatment options with a board-certified physician, you may need to consider the role of the Inspire hypoglossal nerve stimulator. Consider some of these questions to ask your surgeon:

  • Am i eligible for surgery?
  • If you couldn't have this operation, what would you recommend as a treatment?
  • How often did they do this procedure?
  • What is your success rate in resolving sleep apnea (AHI greater than 5)?
  • How many patients have complications such as bleeding, infection, or removal of the device?
  • How do I know if therapy is right for me?
  • Do you have support to go through the insurance approval process?
  • Will I be tested after device placement to determine setting and response to therapy?
  • Who will I follow up with after the surgery is complete?

There may be additional considerations depending on your specific circumstances.

Identify good candidates

After consulting with a sleep surgeon, you will most likely have a procedure called drug-assisted sleep endoscopy to assess your anatomy. In a controlled environment, a drug will be given to induce loss of consciousness and muscle relaxation.

This helps determine if the airways are completely destroyed on all sides. Otherwise, the operation may be ineffective and the procedure will not be completed.

Some patients who are said to be unresponsive may not benefit from Inspire treatment. This is more likely if the airways appear to be completely destroyed on all sides during the endoscopy procedure. If this test shows adequate anatomy, surgery will be scheduled.

Install Operation for Inspire

The Inspire must be placed during surgery under general anesthesia in the operating room. Once you are identified as a candidate, a specially trained ear, nose and throat (ENT) specialist will perform the surgery on an outpatient basis.

A stimulation lead is inserted into the hypoglossal nerve and wrapped around one of its distal branches. A second sensory wire is placed across the chest to detect respiration, so that the muscles of the tongue and airways can be stimulated at the right time when inhalation comes.

Finally, the stimulator itself is placed on the upper right chest wall and connected to the transducers. The whole procedure takes about two hours.

After surgery, patients usually go home if there were no complications. Most do not require the use of narcotic pain relievers.

It is recommended to avoid physical activity for two to three weeks after surgery. You can follow your normal diet without making the necessary changes.

Efficiency

Inspire airway stimulation is a relatively effective treatment for moderate to severe obstructive sleep apnea when CPAP is not tolerated.

Studies have shown that after 12 months it reduces the AHI from an average of 29.3 to 9.0 events per hour, which is 68%. It should be noted that the residual AHI still represents mild sleep apnea. This may improve as therapy is optimized and suitable candidates are identified.

It also improves excessive daytime sleepiness. The Epworth Sleepiness Scale improved from 11 to 6 with treatment, indicating a decrease in daytime sleepiness.

When the device is turned off, sleep apnea mostly returns.

Complications

There are several issues with the Inspire's location. Approximately 25% of the patients complained of relatively moderate pain. Approximately a third of the patients complained of discomfort or abrasion on the tongue, but this seems to have disappeared with time.

About 1% developed a skin infection or irritation (cellulitis) as a result of the operation, and another 1% had to undergo another operation to correct the position of the device.

Side effects and risks

Treatment is generally well tolerated after healing after surgery. Some people find that the sensation inside the tongue causes discomfort when the device is activated during sleep. This rarely requires intervention. Additional side effects include:

  • Heavy bleeding
  • Nerve damage
  • Infection
  • Allergic reaction or rejection of implanted materials.
  • Constant pain at the implantation site.
  • Discomfort from stimulation
  • Tongue pain or weakness
  • Limitations of the movement of the tongue.
  • Difficulty swallowing or speaking
  • Scars or fibrosis around the implant.
  • Dry mouth
  • Insomnia
  • Other acute symptoms (eg, headaches, cough, choking)

If symptoms persist, you should discuss the severity and consequences with your surgeon.

Device tracking and use

After the operation is complete, patients return to the surgeon for a postoperative examination after 7 to 10 days. The device turns on after a month. A sleep study at the center is recommended after two months to assess its effectiveness and adjust settings.

Once in place, the Inspire Stimulator can be activated at bedtime. Generally, it takes 30 minutes before stimulation begins. If you wake up at night, the device can be paused. Often turns off after 8 hours.

Inspire cost of operation

How much does the treatment cost? The Inspire currently costs between $ 30,000 and $ 40,000 to install, including operating costs, and it could cost another $ 17,000 to replace the battery. These costs may be covered by insurance.

Get the word of drug information

If you would like more information on the Inspire Upper Respiratory Tract Stimulator as a treatment option, please contact your nearest healthcare provider to discuss the option. Sleep professionals can also provide information on alternative therapies, including the optimized use of CPAP, oral appliances, and other therapies.

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