Precise location of the blockage involved in the OSA is crucial to the surgical approach, he added. “It’s extremely important that we know exactly where the blockage is in the upper airway,” he said.
Explore This IssueMarch 2015
“Whether it be anterior-posterior, lateral obstruction, or concentric collapse, you need to use different techniques to address those problems.”
At his center, Dr. Lin and his colleagues recently analyzed data to see why some patients respond to surgery and some don’t. They identified three factors: the well-known predictor of body-mass index, the apnea-hypopnea index (AHI), and the presence of lateral velopharyngeal collapse.
Upper Airway Stimulation
M. Boyd Gillespie, MD, professor and director of the Medical University of South Carolina Snoring Clinic in Charleston, talked about the emergence of the upper airway stimulation system, Inspire (Inspire Medical Systems, Maple Grove, Minn.), which received FDA approval in April 2014.
The device is an implantable nerve stimulator that’s similar to a pacemaker, indicated for patients with moderate to severe OSA (AHI of 20 or higher but not greater than 65) who failed or couldn’t tolerate positive airway pressure treatment. “Patients with OSA have reduced neural tone,” said Dr. Gillespie, who has worked as a consultant for the manufacturer. “So it may not be all due to fat in the tongue. Some of it may be due to reduced neural tone. … What we’re trying to do with upper airway stimulation is to account for that loss of neural tone by providing more neural impulse to these glossal groups that perform the dilator function.”
In findings published last year, the system led to a 68% reduction in AHI and a 70% reduction in oxygen desaturation index (ODI) (N Engl J Med. 2014;370:139-149). Those with a complete concentric collapse of the airway were excluded because preliminary studies found that they didn’t respond to the treatment.
Stacey Ishman, MD, MPH, surgical director for the Upper Airway Center at Cincinnati Children’s Hospital Medical Center, discussed treatments for glossoptosis.
She reviewed recommendations from the European Respiratory Society Task Force on non-CPAP therapies in sleep apnea. Task force members cautioned that multi-level surgery is not recommended as a substitute for CPAP, only as a salvage procedure after CPAP and other more conservative approaches have failed, since success of such surgery is often unpredictable and less effective than CPAP.