Also see ats patient information series fact sheet on sleep studies. Upper airway electronic stimulation effective for obstructive sleep apnea uh case medical center one of u. Obstructive sleep apnea osa is an increasingly prevalent clinical problem with significant effects on both personal and public health. With submental stimulation, the apnea index, apnea timetotal sleep time, longest apnea duration, and the number of times per hour that oxygen saturation dropped below 85% decreased significantly compared with those on control nights. Contraction of the genioglossus gg has been shown to improve upper airway patency. This new method of hypoglossal nerve stimulation to treat sleep apnea does so bilaterally. Investigations to localize the site of functional obstruction in the upper airway have shown that there is rarely a single site of occlusion. University hospital of angers, france 19department of respiratory and sleep medicine, university hospital of angers. Some degree of impaired upper airway anatomy is a prerequisite for osa narrow. Longterm costeffectiveness of upper airway stimulation for.
Inspire is an implanted device inserted into your body that monitors and works with your breathing to ensure your airway stays open when you sleep. Stimulation of the hypoglossal nerve, which innervates intrinsic and. Effects of submental electrical stimulation during sleep on. Effects of upperairway stimulation on sleep architecture. Continuous positive airway pressure cpap is the firstline treatment, but has a low adherence rate 4. Effect of upper airway stimulation on vascular function in. Upper airway stimulation therapy and sleep architecture in. An elevated body mass index bmi influences the severity of disease and treatment options utilized for obstructive sleep apnea osa. Jun 16, 2014 after 2 decades of suffering from sleep apnea and an intolerance for conventional treatments, denise hoover of pittsburgh becomes the first recipient of a new fdaapproved procedure. As alternatives, upper airway reconstructive surgeries involving soft tissue and. Prospective, multicenter, cohort study of 126 patients with moderate to severe osa who. In this uncontrolled cohort study, upper airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea. Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnea authors peter r. Upper airway stimulation promising for sleep apnea medscape.
Cpap positive airway pressure pap treatment uses a machine to pump air under pressure into the airway of the lungs. Original contribution operative technique of upper airway stimulation. The lowest arterial oxygen saturation and the duration of sleep stages iii and iv increased significantly. Upper airway stimulation uas has been shown to be safe and. Upper airway stimulation treatment for obstructive sleep. Osa occurs when the tongue and other soft tissues of the throat relax during sleep and obstruct the airway. A major determining factor of upper airway patency during sleep is the activity of the genioglossus muscle. Surgical treatments for obstructive sleep apnea osa guidelines this policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract.
This new technology, which was recently approved by the fda, offers a subset of patients an effective therapy, says dr. Tucker woodson, mdg from the adepartment of otorhinolaryngology, head and neck surgery, sleep disorders center, university. Untreated obstructive sleep apnea osa is a significant public health problem. Broujerdi and others published upper airway stimulation in patients with obstructive sleep apnea undergoing maxillomandibular advancement find, read and cite. The peripheral arterial tonometry ratio related to obstructive episodes will be improved with increasing levels of upper airway stimulation. Patientreported outcomes after 48 months of followup. Nasal dilator devices for treating obstructive sleep apnea osa. Jun 01, 2015 obstructive sleep apnea osa is characterized by repetitive collapse of the upper airway during sleep resulting in nocturnal hypoxemia and recurrent arousals. Effect of upper airway stimulation on vascular function in obstructive sleep apnea the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Schwartz2 1department of medicine b, bnaizion medical center, technion, haifa 31048, israel.
Upper airway stimulation uas has emerged as an innovative and effective therapy for some patients with obstructive sleep apnea osa who cannot tolerate continuous positive airway pressure cpap. Upper airway stimulation star trial conclusions pathogenesis of obstructive sleep apnea ajrccm 2005 172. Obstructive sleep apnea, or osa, arises from what is basically a mechanical problem. Eisele,3 larry allan,2 hartmut schneider,2 roy testerman,4 and alan r.
Obstructive sleep apnea osa is a sleep related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. During sleep the patients tongue falls back against his or her soft palate, and the soft palate and uvula fall back against the back of the throat, effectively closing the airway. Upper airway stimulation as treatment for sleep apnea. Obstructive sleep apnoea cycle obstructive sleep apnoea osa is a sleeprelated respiratory condition, leading to repeated temporary cessations of breathing because of a narrowing or closure of the upper airway during sleep. Clinical trial underway to evaluate upper airway stimulation. Obstructive sleep apnea syndrome osas is an important disease that represent a challenge for both patients and physicians to reach optimum choice for treatment mostly because genesis of osas is multifactorial. With this study, we aim to evaluate a cohort of patients undergoing upper airway stimulation uas for treatment of osa and assess the impact of bmi on surgical and quality of life outcomes. Upperairway stimulation for obstructive sleep apnea. This surgically implanted device combats the underlying hypotonia seen in osa by coupling respiratory effort with upper airway muscle stimulation. Upper airway response to electrical stimulation of the. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea arie oliven,1 daniel j.
Jan 08, 2014 obstructive sleep apnea osa, the most common form of the sleep disorder affects an estimated 18 million americans, with more than half of those suffering from the disorder being overweight. This provides pneumatic splint to your throat which holds it open through an air cushion effect. The literature on upper airway neurostimulation was surveyed from july 20 to july 2019, with a focus on the components of devices, evidence for clinical utility, and adverse events. Upper airway stimulation uas is a new approach to treat moderatetosevere obstructive sleep apnea. In this bulletin segment, the american academy of otolaryngologyhead and neck surgery foundation aaohnsf outcomes research and evidencebased medicine orebm committee shares highlights from a 2017 study, upper airway stimulation for obstructive sleep apnea. When surgery for obstructive sleep apnea and upper airway resistance syndrome is not covered the following surgical procedures are not covered. Surgery for obstructive sleep apnea and upper airway resistance syndrome the hypoglossal nerve stimulation device should only be implanted by a provider who has undergone procedurespecific training.
After 2 decades of suffering from sleep apnea and an intolerance for conventional treatments, denise hoover of pittsburgh becomes the first recipient of a new fdaapproved procedure. Uas is a nonanatomic surgical treatment with longte rm benefit for individuals with moderate to severe osa who have failed nasal continuous positive airway pressure. Upper airway stimulation has been shown to be an effective treatment for some patients with obstructive sleep apnea. Selective upper airway stimulation for obstructive sleep apnea. Diagnosis coding for uas implantation may involve the following code. These episodes of obstruction are associated with recurrent oxyhemoglobin desaturations and arousals from sleep 1. Smith, md electrical stimulation of the tongue musculature and the hypoglossal nerve can improve inspiratory airflow in patients with obstructive sleep apnea osa without arousal from sleep. Abstract selective upper airway stimulation uas is a novel therapy for patients with obstructive sleep apnea. See cpap for pediatric obstructive sleep apnea, section on choosing the right equipment and cpap for pediatric obstructive sleep apnea, section on barriers to effective cpap therapy in children. Safwan badr, md, mba chair, department of medicine, wayne state university school of medicine. Conceptually, the upper airway is a compliant tube and, therefore, is subjected to collapse 2. This novel approach is the first to combine sleep surgery techniques with a titratable medical device for the treatment of osa. Inspire upper airway stimulation for sleep apnea is a system that involves a surgical procedure to implant 3 components.
Using a multicenter, prospective, singlegroup, cohort design, we surgically implanted an upper airway stimulation device in patients with obstructive sleep apnea who had difficulty. Longterm response of upper airway stimulation in obstructive sleep apnea. Upper airway stimulation for obstructive sleep apnea n engl j med 370. The emerging option of upper airway stimulation therapy. Upper airway electronic stimulation effective for obstructive sleep apnea. Upper airway stimulation response in older adults with.
Previous studies identified patient selection criteria for therapy success in upper airway stimulation inspire medical systems, usa for treatment of moderatetosevere osa in patients intolerant to continuous positive airway pressure. Upper airway exercises in patients with obstructive sleep apnea. Upper airway stimulation for treatment of obstructive sleep apnea. Upper airway stimulation maintained a sustained benefit on patientreported outcomes ess, fosq, snoring at 48 months in select patients with moderate to severe obstructive sleep apnea. Nerve stimulation for the treatment of obstructive sleep apnea. Osa, when untreated, deprives people of a healthy sleep, which can cause severe daytime sleepiness.
Obstruction more commonly occurs at multiple levels of the upper airway during episodes of. Now, a new form of treatment, upper airway electronic stimulation, has shown effectiveness in helping a large portion of study participants get much. Department of otolaryngology head and neck surgery faculty. May 01, 2015 upper airway stimulation uas is a new approach to treat moderatetosevere obstructive sleep apnea. Upperairway electronic stimulation effective alternative for. The star trial found uas to be highly efficacious, with a median 68% decrease in apnea hypopnea index. In the present study, we evaluated responses in upper airway pressureflow relationships during sleep to electrical stimulation es of the gg in patients with obstructive sleep apnea.
Selective upper airway stimulation uas is a novel therapy for patients with obstructive sleep apnea osa. Upperairway electronic stimulation effective for obstructive. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. The therapeutic efficacy of upper airway stimulation uas as treatment of obstructive sleep apnea osa has gained an enormous worldwide interest, in particular since the publication of the star trial 12 months results in new england journal of medicine nejm in early 2014. Upper airway stimulation in patients with obstructive sleep. Inspire upper airway stimulation for obstructive sleep apnea. Upperairway stimulation for obstructive sleep apnea nejm. Progesterone stimulation of upperairway muscles and ventilation may contribute to the lower prevalence of obstructive sleep apnea among premenopausal. Upper airway stimulation for treatment of obstructive. Activation of this muscle via stimulation of the hypoglossal nerve is a creative new approach for treatment of obstructive sleep apnea osa. Inspire upper airway stimulation uas therapy is used to treat a subset of patients with moderate to. Upper airway muscle exercises outcome in patients with.
Upper airway stimulation in patients with obstructive sleep apnea undergoing maxillomandibular advancement. Pdf upperairway stimulation for obstructive sleep apnea. Paramount applies coding edits to all medical claims through coding logic software. Fully implanted device represents new treatment option for. Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation.
Jan 09, 2014 university hospitals case medical center. With positive airway pressure, central sleep apnea occasionally emerges. Department of otolaryngology head and neck surgery faculty, presentations and grand rounds. Upper airway muscle stimulation for obstructive sleep apnea. Anatomic predictors of response and mechanism of action of. The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the postimplantation polysomnography in uas in. Keywords obstructive sleep apnea, cranial nerve, hypoglossal nerve, sleep, device, implant, long term, clinical, apnea hypopnea index, sleep. Given that airway obstruction in osa only occurs during sleep, the. Upper airway stimulation to treat adult obstructive sleep.
Upper airway stimulation in patients with obstructive. New study finds upper airway electronic stimulation effective for obstructive sleep apnea uh case medical center one of us and european clinical trial sites showing marked improvements for sleep. Hypoglossal nerve cn xii stimulation for obstructive sleep apnea osa demonstrated safety and efficacy at 12 months in a cohort of participants with moderate to severe osa who were unable to accept or adhere to positive pressure therapy. Bilateral hypoglossal nerve stimulation for treatment of. Upper airway stimulation 5year outcomes and questioning whether sleep apnea treatment improves health posted june 14, 2017 by dr. Obstructive sleep apnea osa syndrome corresponds to recurrent episodes of partial or complete pharyngeal collapse occurring during sleep. Obstructive sleep apnea osa is a disorder caused by relaxation of soft tissues in the upper airway during sleep, leading to airway collapse, interrupted breathing. Recently, 12month data from the stimulation treatment for apnea reduction star trial were reported, evaluating the effectiveness of uas in patients intolerant or nonadherent to continuous positive airway pressure therapy. To quantify changes in sleep architecture before and after upper airway stimulation uas therapy in patients with obstructive sleep apnea. Effect of upper airway stimulation on cardiovascular. New study finds upperairway electronic stimulation effective.
During a sleep study, your breathing, heart rate, and oxygen levels will be monitored. Obstructive sleep apnea can be caused by an anatomic abnormality that narrows or obstructs the airway. Kezirian is an internationallyrecognized expert in the surgical evaluation and. As illustrated in the figure, there are numerous possible causes of upper airway ua collapse as well as complex interactions. Sleep apnea can be effectively treated, and there are a number of ways to do so. Kezirian is an internationallyrecognized expert in. The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the postimplantation polysomnography in uas in patients with osa. Upper airway stimulation for obstructive sleep apnea. The treatment of choice for obstructive sleep apnoea is called nasal continuous positive airway pressure or cpap. Inspire upper airway stimulation for sleep apnearole of. Longterm costeffectiveness of upper airway stimulation. Aug 09, 2016 inspire upper airway stimulation for sleep apnea is a powerful and exciting treatment for many patients who do not succeed with positive airway pressure therapy for example, cpap or bpap.
Effects of upperairway stimulation on sleep architecture in. Determine the impact of upper airway stimulation on peripheral arterial tonometry ratio related to obstructive episodes in this cohort of patients with moderatesevere obstructive sleep apnea. May 09, 2016 clinical trial underway to evaluate upper airway stimulation therapy for sleep apnea in adolescent patients with down syndrome. It is an established health concern affecting up to 5% of middleaged men and women in the general population. Upper airway exercises in patients with obstructive sleep. The clinical guideline for the evaluation, management and longterm care of obstructive sleep apnea in adults released by the adult obstructive sleep apnea task force of the american academy of sleep medicine epstein et al, 2009 state that positional therapy, consisting of a method that keeps the patient in a nonsupine position, is an. Upper airway stimulation uas is an alternative treatment option for patients unable to tolerate continuous positive airway pressure cpap for the treatment of obstructive sleep apnea osa. This involves a pump that provides air under gentle pressure to a mask that covers your nose. Upper airway muscle stimulation for obstructive sleep apnea m. However, the mechanism by which hypoglossal nerve stimulation increases upper airway caliber is not clear. Kezirian, md, mph discusses upper airway stimulation, a new treatment for obstructive sleep apnea. Boon, md, maurits, upper airway stimulation for treatment of obstructive sleep apnea 2015. Keywords obstructive sleep apnea, cranial nerve, hypoglossal nerve. Obstructive sleep apnea american academy of sleep medicine.
Obstructive sleep apnoea osa is characterized by repeated episodes of upper airway collapse resulting in oxygen desaturation during sleep, and leading to cardiovascular and neurocognitive sequelae1, 2, 3. Listing a study does not mean it has been evaluated by the u. Obstructive sleep apnea in adults medical clinical policy. Fda approves inspire upper airway stimulation uas therapy for obstructive sleep apnea fully implanted device represents new treatment option for patients unable to use cpap minneapolis, minn.