Inspire Therapy Now Offered for CPAP-Intolerant Sleep Apnea

Obstructive sleep apnea that goes untreated can lead to fatigue, impaired concentration and an increased risk for motor vehicle accidents. It also has been associated with hypertension, arrhythmia, stroke and heart failure.

The first-line treatment is continuous positive airway pressure (CPAP). Yet, a sizable percentage of people are intolerant to CPAP for reasons such as aerophagia (excessive air swallowing) and claustrophobia while wearing a mask. Traditionally, surgical options were limited, so many opted to stop treatment.

This spring, Lehigh Valley Health Network (LVHN) began offering a newer alternative for these people, known as Inspire therapy. It uses an implantable device to stimulate the hypoglossal nerve, causing the tongue to push forward during inspiration and create more space in the upper airway.

“We are excited to have something else to offer sleep apnea patients who can’t make CPAP work for them,” says Aileen Love, MD, pulmonology-sleep medicine lead for the Inspire program at LVHN.

Recent treatment advances This treatment approach has been studied for several years at large medical centers. Research has demonstrated good outcomes in appropriately selected individuals. Over time, there also have been important refinements in the therapy. “The latest Inspire device is MRI compatible, unlike an older model,” says Niketu Patel, MD, ENT co-lead for the Inspire program. “In addition, only two incisions are required for the surgery now, versus three in the past.”

The process begins with a thorough evaluation by a pulmonology-sleep medicine specialist. To be considered for Inspire therapy, individuals must meet a number of specific criteria:

1. Age 18 or older
2. Sleep study within the past two years
3. Moderate to severe obstructive sleep apnea (apnea-hypopnea index of 15-65)
4. History of failed CPAP use
5. Body mass index of less than 32 for private insurance or less than 35 for Medicare

The next step for individuals who meet these criteria and are interested in Inspire treatment is referral to an ENT clinician. The ENT Inspire team also includes Hilary Koprowski, MD.

The pre-surgical assessment includes a drug-induced sleep endoscopy. Individuals with only posterior-anterior collapse of the palate are potential candidates for the treatment, while those with complete concentric collapse are not.

In people who receive the treatment, an ENT surgeon implants the hypoglossal stimulation device during an outpatient procedure. Recovery is generally rapid. A month later, patients return to pulmonology-sleep medicine to activate the device and begin titrating the signal amplitude.