COPD & Emphysema Support Group
COPD is a progressive disease characterized by airflow obstruction or limitation. Emphysema is characterized by loss of elasticity of the lung tissue, destruction of structures supporting the alveoli and of capillaries feeding the alveoli. Both have symptoms that include shortness of breath, among other respiratory troubles. If you are a COPD or Emphysema sufferer, join...
Implantable tongue-buzzer improves obstructive sleep apnea by 70% (NEJM)
Hypoglossal Nerve Stimulation Markedly Improves OSA
An estimated 15% of men and 6% of women in the U.S. have clinically significant obstructive sleep apnea, meaning it worsens their daytime cognitive functioning, cardiovascular risk, or both. In obstructive sleep apnea, muscle tone in the soft tissues of the pharynx (throat) is insufficient to prevent them from intermittently collapsing during sleep, usually because of obesity. With each closure of the upper airway (failed breath, or apnea), hypoxemia and heart strain can occur, relieved when the sleeping brain arouses itself just enough to buzz the pharyngeal muscle tissues with enough nerve stimulation to restore muscle tone, airway patency and airflow. Because this almost all happens without frank awakenings, most people with obstructive sleep apnea are unaware of their nocturnal troubles or their severity.
Continuous positive airway pressure delivered by mask to the nose or face can dramatically improve obstructive sleep apnea, and probably reduces the risk for cardiovascular complications in severe OSA (this part may never be proven: the benefit has been suggested strongly enough in observational studies that long-term randomization to placebo/sham would be considered unethical for severe OSA). However, most people with obstructive sleep apnea are not treated at all, and fewer still wear CPAP consistently enough to get its full benefit (which probably requires 7 hours a night). Custom oral appliances are less effective, and have always been a boutique, cottage industry, never a plausible public health solution.
So we have a chronic, largely incurable medical condition affecting a large proportion of U.S. citizens, most of whom cant or wont use the best available noninvasive treatment. A glass-half-empty person might get mopey and whine about the human consequences of the obesity epidemic, perverse incentives in U.S. food policy, blah, blah, blah. But not Medtronic, one of the worlds largest device manufacturers best known for its implantable cardiac defibrillators and pacemakers.
Medtronics engineers put together the Inspire I, an implantable hypoglossal nerve stimulator, with a lead in the base of the tongue that triggers when an implanted intrathoracic pressure sensor detects inspiratory efforts. Back around 1999, Alan Schwartz et al implanted the Inspire I device in 8 patients with severe obstructive sleep apnea. It worked brilliantly, improving the apnea-hypopnea index (AHI) by >50% without adverse effects at 6 months, although five of the devices stopped working (it was a prototype). Sensing opportunity, Medtronic spun the company off as Inspire Medical Systems, but remains its largest investor, according to Inspires website. Several other small trials have demonstrated the feasibility of hypoglossal nerve stimulation since then; at least one negative trial has reportedly occurred, but is apparently unpublished.
This month, Patrick Strollo, Kingman Strohl et al report the results of the STAR Trial, a multicenter cohort study to test the latest version of the Inspire device on a larger group of people with obstructive sleep apnea, in the New England Journal of Medicine.
What They Did
Investigators enrolled subjects aged 31 to 80 (mean 54) with moderate-to-severe OSA (mean AHI ~32) and a history of nonadherence with CPAP. Most were men, overweight but not obese (mean BMI 28; patients with BMI over 32 were excluded). All screened patients had to undergo upper endoscopy with airway visualization during sedation-induced sleep, excluding those unlikely to benefit from nerve stimulation.
They then surgically implanted the Inspire device into 126 patients, usually during an overnight stay in the hospital:
http://pulmccm.org/main/2014/randomized-controlled-trials/implantable-tongue-buzzer-improves-obstructive-sleep-apnea-70-nejm/?art=&utm_source=Email+Updates+from+PulmCCM&utm_campaign=47002ff0c5-jan_20_2014&utm_medium=email&utm_term=0_e9d9e09c7c-47002ff0c5-312007369
Hope your all well,
Stay warm and enjoy the snow,
Easy breathing to each of you,
Love Always, Holly
Hypoglossal Nerve Stimulation Markedly Improves OSA
An estimated 15% of men and 6% of women in the U.S. have clinically significant obstructive sleep apnea, meaning it worsens their daytime cognitive functioning, cardiovascular risk, or both. In obstructive sleep apnea, muscle tone in the soft tissues of the pharynx (throat) is insufficient to prevent them from intermittently collapsing during sleep, usually because of obesity. With each closure of the upper airway (failed breath, or apnea), hypoxemia and heart strain can occur, relieved when the sleeping brain arouses itself just enough to buzz the pharyngeal muscle tissues with enough nerve stimulation to restore muscle tone, airway patency and airflow. Because this almost all happens without frank awakenings, most people with obstructive sleep apnea are unaware of their nocturnal troubles or their severity.
Continuous positive airway pressure delivered by mask to the nose or face can dramatically improve obstructive sleep apnea, and probably reduces the risk for cardiovascular complications in severe OSA (this part may never be proven: the benefit has been suggested strongly enough in observational studies that long-term randomization to placebo/sham would be considered unethical for severe OSA). However, most people with obstructive sleep apnea are not treated at all, and fewer still wear CPAP consistently enough to get its full benefit (which probably requires 7 hours a night). Custom oral appliances are less effective, and have always been a boutique, cottage industry, never a plausible public health solution.
So we have a chronic, largely incurable medical condition affecting a large proportion of U.S. citizens, most of whom cant or wont use the best available noninvasive treatment. A glass-half-empty person might get mopey and whine about the human consequences of the obesity epidemic, perverse incentives in U.S. food policy, blah, blah, blah. But not Medtronic, one of the worlds largest device manufacturers best known for its implantable cardiac defibrillators and pacemakers.
Medtronics engineers put together the Inspire I, an implantable hypoglossal nerve stimulator, with a lead in the base of the tongue that triggers when an implanted intrathoracic pressure sensor detects inspiratory efforts. Back around 1999, Alan Schwartz et al implanted the Inspire I device in 8 patients with severe obstructive sleep apnea. It worked brilliantly, improving the apnea-hypopnea index (AHI) by >50% without adverse effects at 6 months, although five of the devices stopped working (it was a prototype). Sensing opportunity, Medtronic spun the company off as Inspire Medical Systems, but remains its largest investor, according to Inspires website. Several other small trials have demonstrated the feasibility of hypoglossal nerve stimulation since then; at least one negative trial has reportedly occurred, but is apparently unpublished.
This month, Patrick Strollo, Kingman Strohl et al report the results of the STAR Trial, a multicenter cohort study to test the latest version of the Inspire device on a larger group of people with obstructive sleep apnea, in the New England Journal of Medicine.
What They Did
Investigators enrolled subjects aged 31 to 80 (mean 54) with moderate-to-severe OSA (mean AHI ~32) and a history of nonadherence with CPAP. Most were men, overweight but not obese (mean BMI 28; patients with BMI over 32 were excluded). All screened patients had to undergo upper endoscopy with airway visualization during sedation-induced sleep, excluding those unlikely to benefit from nerve stimulation.
They then surgically implanted the Inspire device into 126 patients, usually during an overnight stay in the hospital:
http://pulmccm.org/main/2014/randomized-controlled-trials/implantable-tongue-buzzer-improves-obstructive-sleep-apnea-70-nejm/?art=&utm_source=Email+Updates+from+PulmCCM&utm_campaign=47002ff0c5-jan_20_2014&utm_medium=email&utm_term=0_e9d9e09c7c-47002ff0c5-312007369
Hope your all well,
Stay warm and enjoy the snow,
Easy breathing to each of you,
Love Always, Holly
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