Upper airway stimulation is a new, innovative way for the ear, nose and throat (ENT) doctors at The Ohio State University Wexner Medical Center to treat people with obstructive sleep apnea.
When you don’t get enough sleep, it can impact your career, relationships with others and overall quality of life. It can also be dangerous, leading to vehicle accidents and other accidents, as well certain medical conditions, such as a heart attack, stroke, obesity and more.
That’s why we’re proud to be one of the few facilities, both in Ohio and the region, to offer upper airway stimulation, a sleep surgery that can benefit those with sleep apnea who have tried other treatments with little success. In fact, we perform more of these surgeries than most other hospitals in the world. If you’re tired of dealing with sleep apnea, our nationally ranked Department of Otolaryngology – Head and Neck Surgery can walk you through this leading-edge treatment to help you attain better sleep.
What is upper airway stimulation surgery?
Upper airway stimulation is a surgical treatment option for patients with obstructive sleep apnea who cannot tolerate other treatments, such as a continuous positive airway pressure (CPAP) machine, other devices or even lifestyle changes. Obstructive sleep apnea occurs when your airway collapses or becomes blocked during sleep, causing your breathing to stop or become very shallow during sleep.
The procedure is also called hypoglossal nerve stimulation.
The procedure uses an implantable device approved by the Food and Drug Administration. The device, called Inspire, is similar to a pacemaker. Inspire monitors your distinct breathing patterns and provides the exact stimulation needed to contract your throat muscles and keep your airway open during sleep.
Long-term studies show that people who have undergone upper airway stimulation surgery experienced:
- A 78% reduction in sleep apnea events
- Reduced snoring, with 85% of bed partners reporting no snoring or only soft snoring
- Improved quality of life and daytime functioning
The device works silently inside your body with your natural breathing process.
Upper airway stimulation (hypoglossal nerve stimulation) is just one of several sleep surgery options offered at the Ohio State Wexner Medical Center. Our sleep doctors and ENT specialists will work with you to determine the best surgical option for you.
How does the Inspire sleep apnea treatment work?
When you have obstructive sleep apnea, the tongue or other soft tissue may block your airway while you’re asleep, creating dangerous breathing problems. The Inspire device delivers mild stimulation to the hypoglossal nerve prevents the tongue from blocking the airway.
The upper airway device is implanted during an outpatient surgical procedure that typically lasts 60 to 90 minutes. While you’re under general anesthesia, two small incisions are made during surgery: one under the chin to connect a wire (called a lead) to the nerve that controls the tongue, and the other below the collarbone to place the battery and the respiratory sensor.
After one month, you’ll meet with a sleep specialist trained in the management of Inspire therapy to activate the device and set initial stimulation parameters. After that, you’ll be able to turn the device on and off using a handheld remote.
The device can be set to start at an interval after you go to bed (typically 30 minutes), allowing adequate time for you to fall asleep naturally. Throughout the night, the device continually monitors your unique breathing patterns, issuing stimulation to the muscles of the tongue only when you inhale, thus reducing obstructive events. Upon awakening, you simply turn off the device using the remote.
Sometimes people may feel stimulation in their tongue while they’re awake, but this can be minimized by adjusting the stimulation settings.
Am I a candidate for upper airway stimulation surgery?
This type of surgery is reserved for people with sleep apnea who have tried other methods of treatment. You might be eligible for the Inspire surgery if:
- You have a confirmed diagnosis of moderate to severe obstructive sleep apnea
- You can’t tolerate using a CPAP machine
- You have a body mass index of 32 or less
- You have the appropriate anatomy as seen on a drug-induced sleep endoscopy
What to expect during upper airway stimulation surgery
If you want to sleep better without the use of a CPAP machine or other device, here’s what you can expect during an Inspire surgery:
Before surgery
Schedule a consultation with Dr. Chio by calling 614-366-ENTS (3687). All potential candidates for upper airway stimulation surgery will need to complete a physical exam and undergo a sleep endoscopy. An overnight sleep study is also required, although results from prior sleep studies may be used. We’ll coordinate and help you schedule the test prior to your appointment with Dr. Chio, if needed.
During surgery
Because you’ll be under general anesthesia and asleep during the procedure, you won’t feel anything. You’ll need someone to drive you to and from the surgery because of the general anesthetic.
After surgery
The recovery period from upper airway stimulation surgery can vary, but most people experience only mild to moderate discomfort in the first few days following the surgery. Tips to help your recovery include:
- Take pain medications — over-the-counter or prescribed — to help minimize soreness
- Avoid strenuous activity for four weeks
- Walk three times a day, though, and practice deep breaths
- Sleep with the head elevated for at least three days
A month following your surgery, after your incisions have healed, you’ll return to our offices to have the Inspire device activated. During the following four weeks, you’ll slowly increase the stimulation amount and finally, another sleep study will be performed to maximize the device’s effectiveness and determine appropriate stimulation levels.
The device battery will need to be replaced 10 to 12 years after implantation surgery.
Risks of upper airway stimulation surgery
The Inspire surgery is very safe with few complications. When complications do occur, they are rare. Nonserious risks include:
- Temporary pain at incision site
- Tongue movement restictions
- Tongue soreness or weakness, though this should improve over time
- Dry mouth
Freda's story: Upper airway stimulation for sleep apnea
Freda suffered from obstructive sleep apnea for 22 years before receiving upper airway stimulation therapy at the Ohio State Wexner Medical Center. Freda explains how the procedure has improved her quality of life.