Experiments test if implant can block sleep apnea

Dec 27, 2010 By LAURAN NEERGAARD , AP Medical Writer
Rik Krohn displays the remote control unit he uses to turn on an experimental nerve stimulator to combat his sleep apnea, Tuesday, Dec. 21, 2010, at his home in Burnsville, Minn. Loud snoring may do more than irritate your spouse: It can signal sleep apnea, depriving you of enough zzzz's to trigger a car crash, even a heart attack. Now scientists are testing if an implanted device might help, keeping sufferers' airways open by zapping the tongue during sleep. (AP Photo/Jim Mone)

(AP) -- Loud snoring may do more than irritate your spouse: It can signal sleep apnea, depriving you of enough zzzz's to trigger a car crash, even a heart attack. Now scientists are beginning to test if an implanted pacemaker-like device might help certain sufferers, keeping their airways open by zapping the tongue during sleep.

Wait, what does your tongue have to do with a good night's sleep?

One of the main causes of obstructive is that the tongue and relax too much during sleep, enough to temporarily collapse and block breathing for 30 seconds or so at a time. The person jerks awake and gasps, a cycle that can repeat itself 30 or more times an hour, depriving patients of crucial .

The idea behind the experimental implant: Stimulate the nerve that controls the base of the tongue with a mild during sleep, and maybe it will stay toned and in place like it does during the day rather than becoming floppy.

By the end of January, Minneapolis-based Inspire Medical Systems plans to begin enrolling 100 apnea patients in a key study in the U.S. and Europe to see if so-called hypoglossal really could work. Two competitors are developing similar implants: ImThera Medical of San Diego says it hopes to begin U.S. studies later next year, and Apnex Medical of St. Paul, Minn., has announced some small-scale testing.

"In this kind of research, we're not looking for little changes," says Dr. Meir Kryger, a specialist at Gaylord Hospital in Connecticut, who is helping to lead Inspire's study. "What we're looking for is actually cure."

More than 12 million Americans have obstructive sleep apnea, according to the National Institutes of Health. It's particularly common in people who are overweight and in middle-aged men, but anyone can have it.

Today's undisputed best treatment, called CPAP, uses special bedtime masks to gently blow air through the nose to keep airways open. But studies suggest at least 30 percent of diagnosed apnea patients won't or can't use CPAP. They cite masks that fit poorly and leak, or say they feel claustrophobic, or rip them off while tossing and turning during the night.

Yet going untreated is more dangerous than just feeling tired. Sleep apnea stresses the body in ways that increase the risk of high blood pressure, , stroke and diabetes. More immediately, severe apnea increases the chance of a car crash sevenfold. Last year, the National Transportation Safety Board recommended that pilots, truck drivers and other commercial transportation operators start being screened for apnea, saying it has been a factor in incidents involving every mode of transit.

Surgeons sometimes try removing part of the roof of the mouth or other soft tissues to treat apnea by widening airways. But it's hard to predict when these difficult operations will help, so they're usually reserved for the most severe cases.

"It got to the point where I'd dread going to bed," says Rik Krohn, 67, of suburban Minneapolis. Sleep studies showed his apnea was awakening him an average of 35 times an hour. He tried five different CPAP masks unsuccessfully before giving up in frustration, and surgeons turned him away.

Enter hypoglossal nerve stimulation.

With Inspire's system, doctors implant a small pacemaker-like generator under the skin near the collarbone, and snake a wire up under the jaw to that tongue-controlling nerve. A sensor at the diaphragm detects when a patient takes a breath, signaling the implant to zap the nerve. Researchers adjust the power so that the nerve is stimulated just enough to keep the tongue from falling backward during sleep but not to stick out. Patients turn on the device at bedtime with a remote control, complete with a timer they can set so they fall asleep before the pulses begin.

"I don't have any idea while I'm sleeping that it's on," says Krohn, the Minnesota man who'd given up on apnea treatment until volunteering for an early Inspire study last year - and says he now gets a good night's sleep. "It's a game-changer for me."

A caveat: Potential participants in Inspire's upcoming study must undergo a special exam where a tube snaked down the airway documents whether a tongue collapse or a problem with some other tissue is the true cause of their apnea, stresses Connecticut's Kryger.

"It's very important to see where the obstruction is and tailor the treatment," agrees Dr. Rick Odland, Krohn's surgeon at Minneapolis' Hennepin County Medical Center. He turned away another potential candidate in earlier testing when that exam showed zapping the tongue would have targeted the wrong spot.

These experiments are only now beginning, with a handful of implants performed so far - and while it's an interesting concept, frustrated patients should try some proven steps first, cautions, Dr. Amy Atkeson of Columbia University Medical Center in New York.

Her advice: Don't give up on CPAP without first seeing an experienced sleep technician to adjust humidity levels and take other steps that not every CPAP prescriber knows to try - and if you're overweight or obese, apnea greatly improves with weight loss.

Explore further: Flu or Ebola? US hospitals prepare for a confusing season

More information: Inspire: http://www.inspiresleep.com

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User comments : 9

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ormondotvos
not rated yet Dec 27, 2010
Here's a better idea: Implant a very small magnet under the tip of the tongue, and a small piece of coated iron between the two bottom front teeth. Adjust strength and size to fit.

Patented idea, incidentally.
Mercury_01
not rated yet Dec 27, 2010
Two words: garden hose.
Walter_Mrak
not rated yet Dec 27, 2010
I stopped breathing 60 times per hour. Even with a powerful CPAP machine, I still stop breathing 30 times per hour. If I jut out my lower jaw, covering my upper front teeth, my airway is open. There are appliances that do this for you if you wish. Perhaps with practice I can train my jaw muscles and mouth to remain in this favourable position for longer and longer periods over time, until it becomes a habit and remains that way for entire nights of restful sleep.

Another way to open the airway is to tilt the head back so that it is lower than the neck. When positioned in this way, the airway remains completely open.
wileruilaer
not rated yet Dec 28, 2010
ormondotvos: sounds slightly weird but interesting at a glance, but are you sure that the compressing force between magnet and iron would not necrotize the thin layer of tounge tissue in between? I do believe that even small amounts of pressure, over longer periods of time, is enough to cause ischemic damage. Hence decubitus - bedsores.
Skepticus
not rated yet Dec 28, 2010
Daily oral sex will tone up the tongue and throat muscles...and it costs nothing..:-)

For the unmarried or without a partner, a lot of singing and reading books aloud probably do the same thing.

Meanwhile, sleeping on the side will help.
kaypee
not rated yet Dec 28, 2010
I experience symptoms of this myself when my weight exceeds 190-200lbs (holidays!) and they go away when I get back down below that. At 5'8", my BMI suggests I'm borderline obese, but you wouldn't think so looking at me. Coincidence? I don't think so -- not from personal experience.

Try something that might actually work...lose...some...weight.
AdamCC
1 / 5 (1) Dec 29, 2010
I experience symptoms of this myself when my weight exceeds 190-200lbs (holidays!) and they go away when I get back down below that. At 5'8", my BMI suggests I'm borderline obese, but you wouldn't think so looking at me. Coincidence? I don't think so -- not from personal experience.

Try something that might actually work...lose...some...weight.


Wow. Just wow. Yes, weight can be a factor, but it is FAR from the only factor. I suffer from severe sleep apnea, and I'm just barely on the high side of normal BMI - aka not overweight.
Skepticus
not rated yet Dec 29, 2010


Another way to open the airway is to tilt the head back so that it is lower than the neck. When positioned in this way, the airway remains completely open.


False statement. by tilting the head back lower than the neck, the masses of slack tongue and throat muscles will descend and block the airway. Even a cursory view of the cross sectional view of the relevant anatomical depiction of the area with regard to gravity will show this fact. This position's help in openning the airway is only useful if you are not sleeping and the concerned muscles are under concious control/attention. Considering the slackness of the aforementioned tisues under gravity while there is a lack of concious control (i.e., sleeping), only side-way sleeping confers any remedy against slack tongue and throat muscles blocking the airway.
_nigmatic10
not rated yet Jan 01, 2011
Electric current? I can see the side effects now. A slight tongue twitching throughout the day coupled with a numb sensation.

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