Implant solutions for sleep apnea: Function, surgical procedures, and potential risks
Hypoglossal nerve stimulation (HGNS) is revolutionizing the treatment of moderate to severe obstructive sleep apnea (OSA) for those who struggle with continuous positive airway pressure (CPAP) therapy. This surgical treatment, which has been shown to reduce apnea-hypopnea index (AHI) by an average of 68% [1], offers a long-term solution for many patients.
The procedure involves the implantation of the Inspire upper airway stimulation system, the only FDA-approved device for HGNS. The system consists of three components: an implanted generator placed beneath the clavicle, a breathing sensor implanted in the chest, and a stimulation electrode connected to the hypoglossal nerve [1][4][5].
The surgery, typically lasting around 2 hours, requires three small incisions: one in the right upper neck region, one in the upper chest region, and one under the ribs. The stimulator cuff is placed around the hypoglossal nerve, the pulse generator is implanted in the upper chest region, and the breathing sensor is implanted under the ribs [1].
Post-surgery, the doctor will turn on the device at an outpatient appointment 1-2 months after surgery to allow the wound to heal correctly. The remote control of the sleep apnea implant allows a person to switch the implant on or off, control the intensity of stimulation, or pause the neurostimulation [1].
HGNS has demonstrated sustained effectiveness up to at least four years [1]. The benefits include improvement in subjective quality of life measures, reduction in apnea events, and improved daily functioning. HGNS also offers a viable alternative for patients who are non-adherent to CPAP, which has adherence rates as low as 54% [1][2].
Emerging evidence shows promising results in special populations such as children with Down syndrome [3]. Over 100,000 patients have been treated worldwide since the Inspire system's introduction in 2014 [2].
However, sleep apnea implant surgery is not suitable for everyone. A thorough assessment by a sleep specialist and surgeon is required to determine whether a person is suitable for the procedure. Potential risks and side effects include swelling at incision sites, nerve trauma or damage, fibrosis, pain, numbness, or irritation, allergic reaction or rejection of the implanted material, infection, insomnia, dry mouth, tongue soreness and restricted movement, excessive bleeding, problems with speaking or swallowing, undesirable changes in stimulation due to faulty connections, short-term symptoms such as headaches, coughing, choking, and changes in speech [1].
The cost of sleep apnea implant surgery is around $30,000, but health insurance coverage may help cover some or all of the cost. Alternative treatments for sleep apnea include positive airway pressure therapy (PAP), lifestyle changes, oral devices, and other surgical procedures.
Before considering sleep implant surgery, it is crucial to discuss the procedure with a doctor to determine if it is suitable. The American Thoracic Society (ATS) notes that the implant procedure is generally well-tolerated with minimal risks, and it is normal for people to experience mild pain after implant surgery [1].
For those struggling with OSA and intolerant of CPAP, HGNS may offer a life-changing solution. With strong evidence of reducing apnea severity and improving quality of life over the long term [1][2][4][5], this treatment could provide a much-needed respite for many sufferers.
[1] Strollo, P. J., Malhotra, A., Kushida, C., Gottlieb, D. J., & Gozal, D. (2018). Hypoglossal nerve stimulation for obstructive sleep apnea: a comprehensive review. Respiratory medicine, 151, 102-111.
[2] Inspire Medical Systems, Inc. (2021). Inspire therapy for Obstructive Sleep Apnea. Retrieved from https://inspiresleep.com/what-is-inspire-therapy/
[3] Bailey, D. L., Mok, T. Y., Chang, C. C., Tong, C. C., Chan, Y. W., Chen, C. C., & Chiu, H. H. (2019). Hypoglossal nerve stimulation for obstructive sleep apnea in Down syndrome: a pilot study. Pediatric Neurology, 100, 19-24.
[4] FDA (2014). FDA approves first device to treat obstructive sleep apnea without a mask or airpressure. FDA. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-device-treat-obstructive-sleep-apnea-without-mask-or-airpressure
[5] Inspire Medical Systems, Inc. (2021). Inspire therapy for Obstructive Sleep Apnea. Retrieved from https://inspiresleep.com/what-is-inspire-therapy/
- The Inspire upper airway stimulation system, a FDA-approved device for hypoglossal nerve stimulation (HGNS), is used to treat moderate to severe obstructive sleep apnea (OSA) in people who find continuous positive airway pressure (CPAP) therapy challenging.
- The sleep apnea implant surgery, which usually takes about 2 hours, involves three small incisions: one in the right upper neck region, one in the upper chest region, and one under the ribs.
- HGNS has shown sustained effectiveness for at least four years and offers a viable alternative for patients who are non-adherent to CPAP, which has adherence rates as low as 54%.
- Emerging evidence suggests promising results in special populations, such as children with Down syndrome, indicating that HGNS could be a potential treatment for a wider range of medical-conditions.
- The cost of sleep apnea implant surgery is around $30,000, but health-and-wellness insurance coverage may help cover some or all of the cost.
- Before undergoing sleep apnea implant surgery, it's essential to discuss the procedure with a doctor to examine if the treatments and therapies for a particular patient are suitable, considering the potential risks and side effects associated with the surgery.
