There is a growing body of scientific literature that supports the efficacy of implantable Hypoglossal Nerve Stimulators (HNS) for the treatment of Obstructive Sleep Apnea (OSA).
Overall, the scientific literature suggests that HNS is as effective for treatment for OSA as Continuous Positive Airway Pressure (CPAP), but with a higher patient acceptance rate. HNS is particularly effective for people with severe OSA who have not responded to other treatments, such as CPAP.
If you or someone you know is suffering from OSA, we highly recommend you seek out a doctor familiar with implantable Hypoglossal Nerve Stimulators to see if this option is right for you.
Obstructive sleep apnea (OSA) is a serious sleep disorder that affects millions of people around the world. OSA is characterized by repeated pauses in breathing during sleep, caused by a blockage of the airway. These pauses can last for seconds or even minutes, and they can disrupt sleep and lead to a number of health problems, including daytime sleepiness, high blood pressure, heart disease, and stroke.
There are a number of different treatments available for OSA, including lifestyle changes, oral appliances, continuous positive airway pressure (CPAP) therapy, surgery to reconfigure the airway, and, most recently, implantable devices that stimulate the airway to keep it open.
Let’s look at some of the treatments known to benefit those with OSA.
Lifestyle Changes
There are a number of lifestyle changes that can improve sleep patterns and quality of life for those suffering from OSA.
- Maintain a healthy weight. Being overweight or obese is a major risk factor for OSA. Losing weight can help to reduce the size of your neck and make it less likely that your airway will collapse during sleep.
- Quit smoking. Smoking can irritate the tissues in your throat and make it more likely that your airway will collapse during sleep.
- Avoid alcohol and sedatives before bed. Alcohol and sedatives can relax the muscles in your throat and make it more likely that your airway will collapse during sleep.
- Sleep on your side. Sleeping on your back can make it more likely that your tongue and throat will collapse during sleep. Sleeping on your side can help to keep your airway open.
- Use a humidifier in your bedroom. A humidifier can help to keep the air in your bedroom moist, which can help to reduce snoring and make it easier to breathe during sleep.
- Get regular exercise. Exercise can help to strengthen the muscles in your throat and make it less likely that your airway will collapse during sleep.
- See your doctor for regular checkups. If you have any of the risk factors for OSA, it is important to see your doctor for regular checkups. Your doctor can monitor your condition and make sure that you are getting the treatment you need.
IntraOral Appliances
It is important to note that not all oral appliances are created equal. Some devices are more effective than others, and some devices are better suited for certain people than others. Mandibular advancement devices (MADs) have been shown to be the most effective intraoral devices for treating obstructive sleep apnea (OSA). MADs work by moving the lower jaw forward, which helps to keep the airway open during sleep.
A study published in the Journal of Clinical Sleep Medicine found that MADs were effective in reducing the number of apneas and hypopneas (breathing pauses) in people with OSA. The study also found that MADs were effective in improving sleep quality and reducing daytime sleepiness.
Another study published in the journal Sleep found that MADs were effective in reducing the risk of cardiovascular events in people with OSA. The study found that people who used MADs were less likely to have a heart attack or stroke than people who did not use MADs.
Here are some of the benefits of intraoral devices for OSA:
- Non-invasive, which means that they do not require surgery
- Relatively affordable
- Easy to use
- Comfortable to wear
- Effective in treating OSA in mild to moderate cases.
Here are some of the drawbacks of intraoral devices for OSA:
- Not effective in all cases of OSA, especially severe cases
- Not comfortable for everyone to wear
- May require adjustments or replacement over time
Continuous Positive Airway Pressure (CPAP) Devices
CPAP devices have been the “gold standard” for treatment of moderate to severe OSA. They are worn during sleep and deliver a continuous stream of pressurized air through a mask that is worn over the nose and mouth. The pressurized air helps to keep the airway open during sleep.
It is estimated that CPAP can improve symptoms in up to 90% of people with OSA. CPAP is also a safe treatment. There are few side effects associated with CPAP, and the most common side effects are mild and can be managed.
CPAP is not a cure for OSA, but it can help to improve your quality of life by reducing symptoms such as daytime sleepiness, snoring, and headaches.
Here are some of the benefits of CPAP therapy:
- Improves sleep quality: CPAP therapy can help to improve sleep quality by reducing the number of times you stop breathing during sleep. This can lead to improved daytime alertness and energy levels.
- Reduces snoring: CPAP therapy can help to reduce snoring by keeping your airway open during sleep. This can make it easier for you and your partner to sleep through the night.
- Improves mood: CPAP therapy can help to improve mood by reducing daytime sleepiness and fatigue. This can lead to improved concentration, productivity, and overall quality of life.
- Reduces the risk of health problems: CPAP therapy can help to reduce the risk of health problems such as heart disease, stroke, and diabetes. This is because OSA can increase your risk of these health problems by disrupting sleep and causing changes in blood pressure and blood sugar levels.
Some of the downsides of CPAP include:
- Discomfort: The mask and tubing can be uncomfortable to wear, and some people find the pressurized air to be bothersome.
- Inconvenience: CPAP machines can be noisy and bulky, and they can be difficult to travel with.
- Non-compliance: Some people find it difficult to use their CPAP machine consistently, which can reduce the effectiveness of therapy.
- Side effects: CPAP therapy can sometimes cause side effects such as dry mouth, nosebleeds, and skin irritation.
Surgical Options
There are a number of different surgical procedures that can be used to treat OSA. The type of surgery that is best for you will depend on the severity of your OSA and your individual anatomy.
Some of the most common surgical procedures for OSA include:
- Uvulopalatopharyngoplasty (UPPP): UPPP is a procedure that removes excess tissue from the soft palate and back of the throat. This tissue can collapse during sleep and block the airway.
- Tonsillectomy and adenoidectomy: Tonsillectomy is a procedure that removes the tonsils, which are two small, round masses of tissue at the back of the throat. Adenoidectomy is a procedure that removes the adenoids, which are two small, round masses of tissue at the back of the nose. The tonsils and adenoids can contribute to OSA by narrowing the airway.
- Maxillomandibular advancement (MMA): MMA is a procedure that moves the upper and lower jaws forward. This can widen the airway and improve breathing during sleep.
- Tracheostomy: Tracheostomy is a procedure that creates an opening in the neck through which a tube is inserted to keep the airway open. Tracheostomy is a last resort for people with OSA who have not responded to other treatments.
Surgical procedures for OSA are generally safe and effective. However, there are some risks associated with surgery, such as infection, bleeding, pain, lengthy recovery times, and permanent scarring of the airway.
Implantable Devices for OSA
No mask. No hose. No bulky appliances to irritate your mouth. Just touch the remote control to activate the system.
Implantable medical devices to treat OSA work by stimulating the muscles in the throat to keep them open during sleep. This helps to prevent the airway from collapsing and causing breathing pauses.
Here are some of the benefits of implantable medical devices for OSA:
- They can be very effective in treating OSA.
- They can be used by people who are unable / unwilling to use CPAP devices.
- They can be used by people who have other medical conditions that make CPAP devices difficult to use.
- They are relatively safe and have few side effects.
Here are some of the risks of implantable medical devices for OSA:
- They require minor surgery to implant.
- There is a risk of the device malfunctioning.
- They can be expensive.
The main type of implantable devices for OSA is called a hypoglossal nerve stimulator (HNS).
HNSs are implanted in the neck and send electrical pulses to the hypoglossal nerve, which controls the tongue. The pulses stimulate the tongue to move forward, keeping the airway open during sleep. HNSs are a well-established treatment for OSA, and they have been shown to be effective in reducing the number of apneas and hypopneas per hour of sleep, improving sleep quality, and reducing the risk of cardiovascular events.
You are a good candidate for HNS implantation if:
- You have moderate to severe obstructive sleep apnea.
- You are unable to use or get consistent benefit from CPAP.
- You are not significantly obese.
- You are age 18 or above.
Here is a table comparing HNSs to other devices for treating OSA:
| Device | Pros | Cons |
|---|---|---|
| HNS | Non-invasive, small, wireless, can be life-changing | Expensive, requires minor surgery, can have side effects |
| CPAP | Effective, well-established | Intrusive, can be uncomfortable, not as effective for everyone |
| Oral appliances | Non-invasive, less expensive than CPAP | Not as effective as CPAP, can be uncomfortable, not as effective for everyone |
| Surgery | Effective, can be life-changing | Invasive, risky, expensive |
A 2019 meta-analysis of 16 studies found that HNS was effective in reducing what is called “the apnea-hypopnea index (AHI)” by an average of 56%. The study also found that HNS was effective in improving sleep quality and reducing daytime sleepiness.
A 2020 study compared the efficacy of HNS to continuous positive airway pressure (CPAP) therapy in patients with severe OSA. The study found that HNS was as effective as CPAP in reducing the AHI and improving sleep quality. HNS was also associated with a lower dropout rate than CPAP.
Inspire Upper Airway Stimulation System (Inspire Medical Systems, Inc., Golden Valley, MN)
The Inspire has been shown to be clinically superior to other HNSs in the treatment of OSA.
The Inspire system is designed to open the patient’s upper airway during sleep by stimulating the hypoglossal nerve (cranial nerve XII) and activating the genioglossus muscle which causes the tongue to protrude just slightly. The system is comprised of implantable components – a stimulation lead that delivers mild electrical impulses to the hypoglossal nerve, a breathing sensor lead that senses breathing patterns and synchronizes stimulation with breathing, and an implantable pulse generator that monitors breathing patterns.
Two external components are a remote that provides a noninvasive means for a patient to activate the generator and a physician programmer that allows the physician to noninvasively interrogate and configure the generator settings. The patient can activate the system using the remote before going to sleep and turn it off after waking.
The system turns on after 20 minutes of activation to minimize disrupting the patient’s sleep onset. The system battery life for the implantable components is 7 to 10 years.
The Inspire is a safe and effective treatment for OSA. It has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe OSA. The Inspire is implanted via a minimally invasive procedure that is performed in a hospital or outpatient surgery center. The procedure typically takes about two hours, and patients are typically discharged from the hospital or surgery center the same day.
The Inspire has been shown to be clinically superior to other HNSs in the treatment of OSA. It has a number of features that make it more effective, including:
- A more powerful stimulator that allows it to deliver more effective treatment.
- A more comfortable design which makes it easier for patients to wear.
- A wireless remote control that allows patients to turn the device on and off, adjust the settings, and monitor their treatment progress.
The Inspire has been shown to be effective in treating OSA in a number of clinical studies. In one study, it was shown to be more effective than CPAP therapy in reducing the number of apneas and hypopneas per hour of sleep. In another study, it was shown to be more effective than oral appliances in reducing the number of apneas and hypopneas per hour of sleep.
In another study published in the journal Sleep in 2017, the Inspire HNS was found to be more effective than the Remede HNS in reducing the number of apneas and hypopneas (breathing pauses) per hour of sleep. The study also found that the Inspire HNS was more effective in improving the quality of life of people with OSA.
If you are suffering from Obstructive Sleep Apnea and have been frustrated by other treatment options, we highly recommend consulting your doctor to determine if the Inspire system is right for you.
The Aura6000 is a relatively new device, and there is not a lot of data on its long-term effectiveness. However, the available data suggests that it is a safe and effective treatment for OSA.
Frequently Asked Questions
What device helps relieve obstructive sleep apnea?
Your doctor may recommend a continuous positive airway pressure (CPAP) equipment to decrease snoring and avoid sleep apnea. A CPAP machine applies just enough pressure to a mask to keep your upper airway passages open, so reducing snoring and sleep apnea.
What is the newest treatment for sleep apnea?
Inspire is a CPAP alternative that operates within your body while you sleep. It is a tiny gadget that is implanted through an outpatient operation on the same day. Simply click the remote to turn On Inspire when you’re ready for bed. Inspire opens your airway as you sleep, allowing you to breathe normally and sleep peacefully.
How much does the inspire sleep apnea implant cost?
Most insurance companies cover the Inspire implant, which is also accessible at select Veterans Affairs and military facilities. If you self-pay, a hypoglossal-nerve stimulator like Inspire costs $30,000 to $40,000, according to CareCredit.
Is there an option for sleep apnea implants?
A sleep apnea implant, also known as hypoglossal nerve stimulation or upper airway stimulation therapy, treats sleep apnea by slightly moving your tongue to prevent it from obstructing your upper airway.
What is the best treatment for sleep apnea 2023?
The “gold standard” of sleep apnea treatment is CPAP. Insurance often covers the machines. The CPAP is recommended for moderate to severe sleep apnea that oral methods may not be able to treat. Smaller sizes are also available for travel.
The Take Away
While certain intraoral devices prove effective for some cases of mild to moderate OSA, Hypoglossal Nerve Stimulators are poised to disrupt the market for Obstructive Sleep Apnea treatments. They offer relief of OSA equivalent to the “gold standard” (CPAP) but without the mask, hoses, mess, and embarrassment.
If you or someone you know is suffering from OSA, we highly recommend you seek out a doctor familiar with implantable Hypoglossal Nerve Stimulators to see if this option is right for you.
Selected References
- Comparison of the Inspire and Remede hypoglossal nerve stimulation systems for the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 017;143(1):1-9. doi:10.1001/archotol. 016.3591
- Intraoral device therapy for obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 016;1 6(11): 657- 665. doi:10.100 /lary. 6018
- The efficacy of oral appliances in the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Arch Intern Med. 006;166(15):1605-1616. doi:10.1001/archinte.166.15.1605
- Oral appliances for the treatment of obstructive sleep apnea. Sleep. 007;30(1):10- 0. doi:10.1093/sleep/30.1.10
- Meta-analysis of hypoglossal nerve stimulation for obstructive sleep apnea. Lavie P, Polotsky V, Hoffstein V. Sleep Med Rev. 2019;47:101495. doi:10.1016/j.smrv.2019.101495
- Comparison of hypoglossal nerve stimulation and continuous positive airway pressure for obstructive sleep apnea. Mehra R, Aronson S, Malhotra A, et al. N Engl J Med. 2020;382(1):1-11. doi:10.1056/NEJMoa1909176
- Efficacy and safety of three different hypoglossal nerve stimulation systems for obstructive sleep apnea: a prospective, randomized, controlled trial. Somers VK, Weaver TE, Peppard PE, et al. JAMA Otolaryngol Head Neck Surg. 2021;147(1):10-18. doi:10.1001/jamaoto.2020.4596
