Clinical perspective. Alan Schwartz, MD, professor of medicine and medical director of the Sleep Center at the Johns Hopkins School of Medicine’s Asthma and Allergy Center in Baltimore, spoke on lessons learned so far on the clinical use of the device. Overall, he emphasized that optimal use of the device requires a team approach in selecting the best patients and optimizing the therapeutic response.
Explore This IssueAugust 2014
What is currently known regarding patient selection is that predictors of poor response may include severe obesity and/or severe sleep apnea, complete concentric pharyngeal collapse, and markedly elevated pharyngeal critical pressure (Pcrit) at baseline.
He emphasized that more work needs to be done to optimize therapeutic responses and highlighted potential ways to do this. These include titrating stimulation to maximize the airflow, excluding patients with complete concentric collapse, stimulating both the lingual protrusors and retractors, and strengthening the lingual muscles with tonic as well as phasic stimulation.
Although he has yet to use the device clinically, Dr. Schwartz plans to offer it to his patients.
For otolaryngologists and other healthcare providers who manage sleep problems in their patients, Dr. Strohl highlighted the need for specialists to work together to optimize responses. He emphasized the need for education and skill training of otolaryngologists and other physicians who manage sleep disorders, as well as a new coordination of care planning among these physicians.
For Dr. Soose, the device provides the best of medical and surgical perspectives. “The treatment is a titratable medical device similar to CPAP or a dental device; however, it is completely implanted under the skin rather than something that has to be strapped on the face or placed in the mouth,” he said. “At the same time, upper airway stimulation therapy is a surgical procedure, but it differs from traditional surgeries in that it does not involve any cutting or rearranging of the tissues in the throat or jaw; therefore, the pain and downtime and recovery are dramatically reduced.”
The device will be available at select medical centers in the U.S. beginning in the second half of 2014, and the manufacturer intends to work closely with medical centers to facilitate insurance coverage for patients who are good candidates for the device.
Disclosures: Both Drs. Strohl and Soose are consultants for Inspire Medical Systems, Inc.