Atlantic Health Sleep Surgery Program at Morristown Medical Center has implanted nearly 150 hypoglossal nerve stimulators (HGNS), commonly known by its trade name, Inspire®. The Morristown Medical Center team is part of a multidisciplinary, collaborative group focused on sleep apnea treatment with special certification to perform this procedure, and are among the few offering Inspire treatment in New Jersey.
Obstructive Sleep Apnea (OSA), a prevalent sleep disorder characterized by pauses in breathing by repeated interruptions by tongue and throat anatomy during sleep, can lead to a myriad of health consequences. These can include morning headaches, daytime sleepiness, trouble concentrating in the short term to impaired cognitive function, and cardiovascular disease in the long term. Many patients with OSA find relief with a continuous positive airway pressure (CPAP) machine, but many patients do not tolerate the device well.
Inspire, the FDA-approved device, has emerged as a game-changer for physicians and their patients seeking an innovative solution, by offering a novel alternative for patients who do not respond well to traditional OSA treatments such as CPAP.
“This small implant, the size of a cardiac pacemaker, stimulates the nerve that moves the tongue forward, keeping the patient's airway open without the mask and hose of a CPAP machine,” says Tom Thomas, MD , director of Sleep Surgery, Head and Neck Reconstructive Surgery, and Transoral Robotic Surgery (TORS) at the Leonard B. Kahn Head and Neck Cancer Institute at Morristown Medical Center.
Clinical studies have demonstrated that Inspire significantly reduces the apnea-hypopnea index (AHI), substantially improving sleep apnea severity. In a study published in 2014, Strollo et al. reported 126 participants saw a 68% 1 reduction in AHI, from 29.3 events per hour to 9.0 events per hour ( P <0.001).
The Inspire treatment procedure involves implanting a small device beneath the skin in the upper chest area. This device is connected to a lead stimulating the hypoglossal nerve during sleep. The hypoglossal nerve controls the muscles of the tongue and other key airway muscles. Inspire helps keep the airway open by stimulating these muscles, preventing the collapse in individuals with OSA.
Once implanted, the device is programmed to stimulate the hypoglossal nerve based on the patient's unique breathing patterns. The patient can activate and deactivate the system using a small remote control.
"There are no visible signs of this device, and the patient has full control over how and when to use it," says Dr. Thomas. "They can turn it on without having any visible structures to the outside world and sleep in any position they like. An additional advantage is that it is completely portable when you are traveling or going camping."
Patients considered for Inspire therapy must:
- Undergo a thorough medical evaluation including history and physical
- examination,
- Have a recent sleep study,
- Undergo a drug-induced sleep endoscopy (DISE) to assess if their throat anatomy is favorable for Inspire treatment.
Candidates with the ideal anatomy have moderate to severe OSA, have not responded well to CPAP therapy, and have a body mass index (BMI) within a specific range.
“Our patients have had very good results so far,” says Federico Cerrone, MD, Medical Director of Atlantic Health Sleep Centers and System Associate Medical Director of Pulmonology, Sleep and Allergy services. “HGN stimulation is another choice we can give to patients.”
"We are hoping to publish our internal data showing that our patients are doing better than the national average that has been published," says Dr. Thomas, MD, "We are choosing patients carefully, implanting them, and seeing that they are doing well in terms of obstructive sleep apnea. You cannot cure somebody with obstructive sleep apnea, but we are coming closer to a point where their quality of sleep is almost back to normal."