Information source: Inspire Medical Systems
How it works: Inspire therapy is an implanted system that senses breathing patterns and delivers mild stimulation to key airway muscles, which keeps the airway open during sleep.
When to try it: after CPAP refusal or failure
Appropriate AHI: 20 to 65
Other considerations: Inspire UAS may be used in adult patients 22 years of age and older who have been confirmed to fail or cannot tolerate CPAP and who do not have a complete concentric collapse at the soft palate level.
Patients who should NOT try it: those with central + mixed apneas >25% of the total apnea–hypopnea index (AHI); any anatomical finding that would compromise the performance of upper airway stimulation, such as the presence of complete concentric collapse of the soft palate; those who will require magnetic resonance imaging (MRI)
New developments in 2014: In January, results from the STAR trial were published in the New England Journal of Medicine. On April 30, the FDA approved Inspire UAS.
Concerns & Responses:
Concern: Infection risk
Inspire: All surgeries carry a small risk of infection. In contrast to other surgical options to treat sleep apnea, Inspire therapy does not require removing or permanently altering an OSA patient’s facial or airway anatomy. As such, the procedure is less invasive and should result in a shorter recovery time. It also does not require a mask or oral appliance. The serious adverse event rate in the STAR trial was <2%.
Concern: It’s uncertain what the long-term side effects are of continuously stimulating the hypoglossal nerve.
Inspire: There have been no reported long-term side effects from stimulating the hypoglossal nerve.
More information: Strollo PJ, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370:139-149.
Sree Roy is editor of Sleep Review. CONTACT [email protected].
1. Vanderveken OM, et al. Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing. Thorax. 2013;68(1):91-6.
2. Remmers J, et al. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Sleep. 2013;36(10):1517-25.
3. Phillips CL, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187(8):879-87.
4. Emsellem HA, Winslow DH, Siegel LC, Bogan RK, McCullough PA, Stiles J. Safety and effectiveness of oral pressure therapy with a new oral interface. SLEEP 2014; 37(abstr suppl):A146(4017).