Sleep Medicine & Sleep Apnea

Introduction

A restful night’s sleep is a critical element of general health. The well-rested mind and body function more efficiently. This is often taken for granted until something interferes with sleep quality. Obstructive sleep apnea (OSA) is a serious condition where the quality of sleep is threatened by cessation of breathing. When this occurs in adults, it is due to the relaxation of throat and tongue muscles during sleep, which results in a collapse of the airway. In children, often large tonsils and adenoids become obstructive when throat muscle relaxation occurs during sleep. Once breathing is obstructed, there is less oxygen supplied to the body and brain.

The normal sleep cycle is then interrupted when the body wakes itself to restore oxygenation. These awakenings, although sometimes brief, result in decreased sleep efficiency, which can cause poor cognitive performance, excessive daytime fatigue, and other detrimental symptoms. Major health issues such as high blood pressure and stroke may also occur. At the Osborne Head and Neck Institute, the quality of your sleep is of vital importance to us. Our cutting-edge approach to sleep medicine has resulted in the implementation of specialized treatment options to address sleep apnea. These non-surgical and surgical techniques have resulted in remarkable improvements to the quality of life and health of our patients, often resulting in complete resolution of obstructive sleep apnea.

Our Team

At the Osborne Head and Neck Institute, we believe that optimal patient care occurs when everyone focuses on their area of expertise. We have assembled a team that includes sub-specialty trained care providers in all disciplines pertaining to the care of the sleep apnea patient.

What is Obstructive Sleep Apnea (OSA)?

Obstructive Sleep Apnea (OSA) is a condition marked by the disruption of breathing during sleep. Most commonly, OSA occurs when the throat and tongue muscles relax during sleep. In certain individuals, this relaxation results in obstruction of the airway and decreased airflow.

When airflow is reduced, oxygen levels in the bloodstream decrease. The brain senses the decrease in oxygen and wakes the body from sleep in order to relieve the obstruction and open the airway. While this achieves the goal of improving oxygenation, the normal sleep cycle has been disturbed for that period of time. Further, falling back asleep results in recurrence of obstruction and loss of oxygen. This cycle of obstruction and awakening repeats throughout the night, causing significant disruption of sleep.

Common symptoms of OSA include daytime sleepiness, difficulty concentrating, irritability, decreased school/work performance, and difficulty concentrating. Lack of oxygenation also strains the heart, brain, and other organs, and, over time, may result in heart attack, stroke, weight gain, high blood pressure, or heart failure.

The normal sleep cycle is then interrupted when the body wakes itself to restore oxygenation. These awakenings, although sometimes brief, result in decreased sleep efficiency, which can cause poor cognitive performance, excessive daytime fatigue, and other detrimental symptoms. Major health issues such as high blood pressure and stroke may also occur. At the Osborne Head and Neck Institute, the quality of your sleep is of vital importance to us. Our cutting-edge approach to sleep medicine has resulted in the implementation of specialized treatment options to address sleep apnea. These non-surgical and surgical techniques have resulted in remarkable improvements to the quality of life and health of our patients, often resulting in complete resolution of obstructive sleep apnea.

What are the current treatment options for OSA?

Treatment options for OSA vary from patient to patient. For some patients, conservative measures result in total resolution of sleep apnea. However, other patients require more advanced techniques. Options include:

• Lifestyle modifications – Conservative measures that may be implemented include losing weight, exercising regularly, and decreasing alcohol consumption before sleep. If this is not possible or does not succeed, CPAP may be recommended.
• CPAP – Continuous Positive Airway Pressure (CPAP) may be used during sleep. This machine comes with a mask that is fitted over the nose or mouth, and delivers air pressure to prevent airway collapse. While this is often successful, some people find it difficult to adhere to this treatment.
• Oral appliances – For those people with OSA due to tongue collapse during sleep, an oral appliance may be prescribed. By moving the jaw forward, the tongue moves forward and obstruction may be prevented.
• Surgical options – If the above options are not successful, surgical options may be considered. There is a large spectrum of available treatments, including tonsil surgery, nasal surgery, and palatal surgery, which may alleviate obstruction. These procedures typically are uncomfortable but have some success at relieving OSA.
• Upper Airway Stimulation Therapy – This cutting-edge procedure has been recently developed and has shown remarkable success at conservative treatment of sleep apnea. This fully implanted system senses breathing patterns and coordinates mild stimulating impulses to key airway muscles, preventing them from collapsing.

What is Upper Airway Stimulation Therapy?

Upper Airway Stimulation Therapy is an advanced, fully implanted system, which delivers small impulses to key airway muscles during sleep to keep them activated and prevent collapse. This device functions with three components: a small generator, a breathing sensor, and a stimulation lead.

The therapy is activated nightly by the patient and deactivated upon awakening, allowing the patient to retain full control of the device.

This unique approach to the treatment of OSA has resulted in resolution of OSA in those patients who do not want CPAP and would like an alternative to traditional airway surgery.

Treatment

Treatment of Obstructive Sleep Apnea (OSA) is highly complex and individualized. Optimized treatment that is unique to each patient’s case is best determined by comprehensive assessment from a specialized team of trained practitioners. At the Osborne Head and Neck Institute, we have made it a priority to stay on the forefront of sleep medicine and surgery. This has allowed us to offer the most diverse and custom treatment plans for patients suffering from OSA. The one-size-fits-all approach does not work well in sleep medicine. We will assess your individual anatomic, social, and medical concerns and ensure that the treatment option selected addresses your particular needs.

Should surgery be indicated, there are many levels of care that may be provided. These include:

• Nasal surgery – For selected patients, advanced nasal surgical techniques have been developed that may completely eliminate OSA. For others, nasal procedures may simply improve the comfort of CPAP, if that option is selected. Managing the nasal airway is a vital component in OSA care.
• Sleep surgery – This includes several procedures that will be carefully selected for your optimal care. Tonsillectomy, adenoidectomy, and palatal procedures fall into this category and may result in resolution of OSA.
• Upper Airway Stimulation Therapy – This advanced implantable device is well-tolerated and may result in resolution of OSA with decreased pain and recovery time compared to traditional surgery.

Upper Airway Stimulation Therapy

Becoming a Candidate

Upper Airway Stimulation Therapy represents a major advancement in treatment of OSA patients. This alternative treatment is not suited for all patients and candidacy must be determined by a qualified team of physicians.

At your initial consultation, we will perform routine as well as complex testing to assess your individual anatomy and general procedure safety. Your Apnea-Hypopnea Index will be determined and, from this, we will further be able to assess if this procedure may work for you.

Frequently Asked Questions

How  does UAS  therapy  work?

UAS therapy is a fully implanted system controlled by the patient. Before bed, the patient simply turns the therapy on. The system consists of three fully implanted components: a small generator, a breathing sensor lead, and a stimulation lead. When activated, UAS therapy continuously monitors breathing during sleep and delivers mild stimulation to key airway muscles, keeping the airway open. There is no mask or oral appliance.

Will UAS therapy address snoring?

Data has shown that 85% of bed partners reported either no snoring or soft snoring for their partners using UAS therapy. Though not intended to treat snoring, significant improvement in snoring has been found.

What does stimulation feel like?

Patients report only a mild sensation from the stimulation. Patients typically feel a tingling sensation or mild contraction of the tongue muscles. The stimulation should not be painful or uncomfortable.

What does the surgical procedure involve?

The UAS therapy system is implanted while the patient is under general anesthesia. This is typically an outpatient procedure, and healing time is decreased compared to traditional sleep surgery. Incisions are made for the insertion and connection of the sensing lead, the stimulation lead, and the pulse generator.

How often does the system need to be checked by my doctor?

Generally, the system should be checked 1-2 times a year. However, you will be advised of your follow up needs based on your particular situation.

Will this system limit my activities?

Generally, activities are not limited by the UAS therapy system. However, it is important to ask your doctor about particularly strenuous activities such as weightlifting, or those that involve significant range of motion of the upper body. Your doctor may ask you to refrain from certain activities.

How long is the recovery time after surgery?

There is usually some pain and swelling at the incision sites for a few days after surgery. Certain patients require an overnight hospital stay; however, many are able to go home on the same day as the procedure. Within a few days of the procedure, normal non-strenuous activities are often safe to perform. A week after surgery, we will perform an examination to ensure proper healing is taking place. Most patients have a full recovery within a few weeks.