Pacemaker To Cure Obstructive Sleep Apnea (OSA)?

The Washington Post on Dec 27, 2010 published a story about a potential new treatment whose goal is  obstructive sleep apnea cure (OSA) cure using a pacemaker made by Inspire Medical... for the tongue.

Apparently it stimulates the nerve going to the tongue (hypoglossal nerve) to contract with every breath a person takes while sleeping.

Why would this help? In some patients with severe obstructive sleep apnea, the tongue falls backward against the throat's back wall (tongue prolapse) causing airway obstruction. By stimulating the tongue's nerve, the tongue is stimulated to move forward when a patient takes a breath preventing obstruction.

Of course, this treatment works ONLY if the obstruction is due to tongue prolapse.

There are other treatments that also accomplish the same thing including:

• Base of tongue coblation/reduction
• Geniohyoid advancement
• Repose procedure
• Oral appliance

At least in our office, we only offer the base of tongue reduction to address tongue prolapse that may lead to obstructive sleep apnea.

This pacemaker for the tongue is currently experimental and not available for the general public yet.

Read the WP article here.

Oral Appliance Can Help With Obstructive Sleep Apnea

In the September 2009 edition of Archives of Otolaryngology Head & Neck Surgery, there was a research paper entitled "An Investigation of Upper Airway Changes Associated with Mandibular Advancement Device Using Sleep Video Fluoroscopy in Patients with Obstructive Sleep Apnea" where use of an oral appliance was found to significantly improve obstructive sleep apnea. The oral appliance increased retropalatal and retrolingual spaces as well as decreased the length of the soft palate and the angle of mouth opening.

Increased retropalatal space and decreased length of the soft palate is similar to what is accomplished by the surgical procedure uvulopalatopharyngoplasty (UPPP).

Increased retrolingual space is similar to what is accomplished by the base of tongue reduction surgery.

Click here to read more about this research.

Click here to read more about OSA and its treatment.

Base of Tongue Coblation for Severe Obstructive Sleep Apnea

Fauquier ENT is offering a relatively new procedure called base of tongue reduction (as well as lingual tonsillectomy) using coblation for patients suffering from severe obstructive sleep apnea (OSA) due to an enlarged base of tongue. For many patients, an enlarged base of tongue is a significant contributing factor leading to severe sleep apnea. This area contributes to obstruction by falling backwards against the back wall of the throat during sleep leading to airway closure.

Although a number of procedures have been offered to minimize this problem in the past such as:

• hyoid advancement
• genioglossal advancement
• repose procedure
• mandibular advancement

None of these procedures directly addresses the tongue bulk/size itself. Rather, these procedures indirectly attempts to address the base of tongue by moving and anchoring the entire tongue forward. As such, these procedures only marginally improves OSA and usually only lasts for a temporary period of time.

Other traditional OSA surgeries such as:

• tonsillectomy
• adenoidectomy
• UPPP (uvulo-palato-pharyngoplasty)
• septoplasty
• turbinate reduction

These address obstructions only at the nasal and oral cavity level of the airway. Base of tongue is BELOW these levels and located immediately above the voicebox (where air enters the windpipe to get to your lungs). As such, many patients who have undergone these surgeries often find themselves still suffering from OSA. Furthermore, enlarged base of tongue is the main cause of OSA in skinny people.

Click here to read more about base of tongue reduction/lingual tonsillectomy offered only at Fauquier ENT of Northern Virginia.

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Non-surgical methods to resolve obstructive sleep apnea due to large base of tongue: