New Methods Emerge in the Treatment Of Obstructive Sleep Apnea

One issue that may curb the use of this device, at least in the near future, is the lack of insurance coverage until there are specific billing codes for the device, according to Eric J. Kezirian, MD, MPH, Director of the Division of Sleep Surgery in the Department of Otolaryngology-Head and Neck Surgery at the University of California, San Francisco. Dr. Kezirian, however, admired the way in which PROVENT therapy has been developed and marketed. I have been very impressed by the approach of Ventus Medical, the makers of the PROVENT, to perform research to understand why and in whom the device works well before they rush it out and just start selling it, he said. This will be critical in helping providers understand to whom they should prescribe the devices as well as helping to support third-party reimbursement.

Currently, PROVENT therapy is available in limited markets to sleep specialists. It is indicated for patients with moderate to severe sleep apnea, but contraindicated for certain populations, such as children and other patients with anatomical abnormalities that are best treated surgically.

Dr. Westbrook, who suggested that otolaryngologists consider this therapy as a reasonable first-line therapy for some patients, also emphasized that otolaryngologists recognize the harm surgery may do in decreasing the efficacy of treatments such as CPAP and EPAP. Although he said that the evidence to date is speculative on this, he urged otolaryngologists to become familiar with the data. He also suggested that there may be a role for a combination of surgery and EPAP, but again emphasized that this was speculative.

Oropharyngeal Exercises

Exercises that strengthen and tone the oropharyngeal muscles comprise another treatment approach that is gaining some traction. Evidence supporting this emerged previously in studies that showed the efficacy of playing the didgeridoo, an Australian musical instrument, in reducing symptoms of sleep apnea (Burkhead et al. Dysphagia 2007;22:251-65).

More recent data come from a randomized trial of 31 patients with moderate obstructive sleep apnea treated by exercises involving the tongue, soft palate, and lateral pharyngeal wall (Guimaraes KC et al. Am J Respir Crit Care Med 2009;179: 962-6). Developed by a speech therapist, the exercises include functions of suction, swallowing, chewing, breathing, and speech. The study found that patients treated with exercises had a significant reduction in severity and symptoms of obstructive sleep apnea compared with a control group as measured by a significant decrease in neck circumference, snoring frequency and intensity, daytime sleepiness, sleep quality score, and AHI.