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implant obstructive sleep apnea — severe sleep disorder A new study finds that the technique, which involves stopping breathing for 10 seconds to two minutes multiple times an hour each night, is most effective in people who are overweight, but not severely obese.
To be eligible for the device, called a hypoglossal nerve stimulator, people 18 years or older who have been diagnosed with moderate to severe obstructive sleep apnea must be eligible for continuous positive airway pressure (CPAP). Either you cannot or you must refuse to wear it. gold standard Treatment of obstructive sleep apnea syndrome.
The new research Published on Thursday In JAMA Otolaryngology—Head and Neck Surgery, they looked at the BMI of 76 patients who received implants, said lead author Dr. Eric Landsness, assistant professor of neurology and sleep medicine at Washington University School of Medicine in St. Louis. Ta. .Louis.
Currently, implant surgery, which costs between $50,000 and $100,000, is approved and covered by Medicare and many insurance companies for people with a BMI of up to 40.
However, “we found that in people with a BMI over 32, this device could fail up to 75% of the time,” Landsnes said. “This was a linear relationship; for each increase in BMI above 32, the probability of successful treatment decreased by approximately 17%.”
as currently definedA BMI of 18.5 to 24.9 is a healthy weight, 25 to 29.5 is overweight, 30 to 34.9 is obese, 35 to 39.5 is class 2 obesity, and anything over 40 is “severe” or class 3 obesity. This is called morbid obesity. If your BMI is less than 18.5, you are considered underweight.
The study also found that implants had a lower success rate in people who slept on their backs, the so-called supine position.
The results of this study are consistent with previous studies demonstrating the effectiveness of this device. But “it also raises the question of whether obesity and supine sleeping limit its effectiveness,” says Kristen Knutson, a sleep specialist and associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. Stated. She was not involved in the study.
“There is a huge unmet need for patients who suffer from obstructive sleep apnea and cannot tolerate CPAP,” Landsnes says. “However, this is always a risky and expensive procedure, so doctors need to make sure that a stimulator is the right choice for the patient.”
To use CPAP, a sleeper places the mask over their nose and mouth, seals the mask to their face with the straps, and turns on the machine, which is connected to the mask with a hose. This machine delivers air at enough pressure to prevent airway collapse during sleep, based on a person’s unique requirements.
But many people find the masks claustrophobic and poorly fit, the tubes constricting and unwieldy, and the air pressure insufficient or too strong. Many people wake up frequently during the adjustment period, and some say they sleep worse than before they started treatment.
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Experts say adjusting the air pressure, mask and tubes required for CPAP can be difficult for some patients.
About one-third of patients have difficulty using CPAP and may eventually abandon it, Landsnes said. If enlarged tonsils, a deviated nasal septum, or excess soft tissue in the throat are causing the apnea, surgery may be needed to treat those problems, he added.
In addition to CPAP and surgery, treatments for obstructive sleep apnea may include minimal treatment, such as dental appliances that move the tongue forward or behavioral changes such as asking you to lose weight and sleep on your side instead of your back. It belongs to.
“Rather than not treating the symptoms and facing the potential health consequences, treatment with a hypoglossal nerve stimulator provides an opportunity that did not previously exist,” explains both neurology and sleep medicine. said Dr. Brandon Peters-Matthews, a board-certified. He was treated at Virginia Mason Medical Center in Seattle. He was not involved in the study.
“Most people recover fairly quickly after surgery, with pain easing within the first few days,” Peters-Matthews said in an email. “The device starts working after a month of use, and you may experience some discomfort as the intensity of stimulation increases. Side effects are unlikely to compromise the treatment.”
US Food and Drug Administration first approved The hypoglossal nerve stimulator was developed in 2014, and to date the device has been implanted in 60,000 people worldwide. Maker. The surgeon inserts a small device, much like a pacemaker, under the skin near the collarbone. Another impulse is placed under the jaw and is connected to the nerve that controls the tongue. Both devices are connected by a wire implanted along the neck.
Activated by remote control at night, the device detects each breath and electrically activates the tongue to prevent airway obstruction.
“We’re basically stimulating the tongue to open up the airway and basically push it forward,” Landsnes said. “The biggest complaint we hear from people is that their tongue gets tired sometimes because the tongue muscles are stimulated so many times.”
However, it can take up to a year from the first doctor’s visit to fully adapt to the device, and many important steps are required along the way, according to Respiratory and Sleep Medicine at Huntington Health in Pasadena. Dr. Raj Dasgupta, an expert on California.
“You will need to visit an otolaryngologist who will perform a procedure called DISE. “Drug-induced sleep endoscopy, in which an endoscope called an endoscope is inserted through the nose to observe collapse of the upper airway,” said Dasgupta, who was not involved in the study.
“If the collapse is from front to back, such as when the tongue drops into the back of the throat, you may be a candidate for surgery,” he says. “Then we have to do a sleep study to see how much stimulation is needed to find the right setting, and sometimes the patient can’t tolerate it.”
Approximately 1 billion people worldwide have moderate to severe obstructive sleep apnea, where breathing stops for anywhere from a few seconds to several minutes, 30 to 100 times per hour. According to estimates. In addition, 425 million people are considered to be in mild to moderate danger, and in these people he stops breathing 5 to 29 times per hour.
Imagine what happens when your body stops breathing or can’t breathe enough. For example, oxygen levels can plummet each night to levels that can send people with breathing difficulties due to COVID-19 to intensive care units during the pandemic.
Prolonged oxygen deprivation can lead to many serious medical conditions, including high blood pressure, coronary artery disease, heart attack, heart failure, stroke, arrhythmia, and heart rhythm disturbances that can cause sudden death. According to the Mayo Clinic.
Obstructive sleep apnea syndrome is is also connected Type 2 diabetes, asthma, obesity, kidney disease, chronic obstructive pulmonary disease, thyroid disease, and even mental illnesses such as depression and anxiety.
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However, many people with this condition are unaware that they are not receiving vital oxygen from their brains and bodies, and often find that their sleep partners snore excessively during sleep. It is often not diagnosed until people complain of two telltale signs: gasping.
“When this happens, people wake up just enough to start breathing, but often not enough to regain consciousness,” Landsness says. “They can remain like this for years without understanding why they have difficulty concentrating, have low energy, and become excessively sleepy during the day.”
New solutions to treat obstructive sleep apnea are desperately needed, so the advent of stimulators is welcome news for doctors eager to provide a solution to their patients. Landsness said.
“As an alternative treatment for sleep apnea, this hypoglossal nerve stimulation surgery could revolutionize the lives of some people,” he said. “Some patients try so hard with CPAP, fail, and cry with joy after they recover. We finally found something that works for them.
“But a person’s weight seems to be an important predictor of whether they will respond well to treatment,” he says. “As a sleep physician, I want to offer this treatment to patients, but I want to offer it to the right patients who will benefit the most.”
