What is Upper Airway Electrical Stimulation (UAS) ?
One of the most recent treatments for obstructive sleep apnea (OSA) is electrical stimulation of the upper airway (UAS).
Marketed under the name Inspire®, it received approval from the US Food and Drug Administration in April 2014 following preliminary studies.
The treatment is not yet approved by Health Canada and therefore Canadian patients cannot benefit from it at this time.
The effectiveness of CPAP is no longer to be proven; this treatment represents the “gold standard” when it comes to treating sleep apnea.
The problem with this treatment is not its ability to open the airways, but rather the patient’s adherence to the treatment.
It is estimated that around 30% of users fail to adapt and do not rigorously use their device.
The electrical stimulation treatment attempts to address this problem.
What is the procedure with Upper Airway Electrical Stimulation surgery ?
During surgery, a small device is implanted under the patient’s skin, at the collarbone.
The device has two wires; the first with a role in detecting respiratory activity, and the second, which sends electrical stimulation to the hypoglossal nerve.
The stimulation can be triggered by each inspiration or continuously to raise the tone of the genio-glosse muscle.
The upper airways remain open at all times to allow optimal air passage.
It is the patient who must activate the device at bedtime using a wireless controller.
Why is Upper Airway Electrical Stimulation is different than others types of surgeries to treat sleep apnea ?
Another aspect that makes this treatment interesting is its conservative aspect.
Several surgeries to treat sleep apnea require modifying the patient’s anatomy.
In the case of treatment with electrical stimulation, the device can simply be removed if it turns out to be ineffective or if complications arise.
Currently, the main study that led to FDA approval of the Inspire® device has been published in the New England Journal of Medicine.
After 12 months of implantation and use, the patients having the device demonstrated a reduction of approximately 70% of their apnea, that is to say a passage of AHI from 29 to 9.
So far, the criteria for patient selection have been well defined.
Patients targeted for this therapy should have an AHI between 20 and 60 and have tried CPAP therapy beforehand.
A body mass index of 32 and below is also recommended and the patient should be aware that he will no longer be able to do certain types of imaging tests.
Here is a short video demonstrating how the Inspire® device works. We publish it with permission from Inspire Medical Systems.