What's New in the World of Sleep Apnea Treatment?

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Thursday, July 4, 2013

a mouthpiece that allows this negative pressure to be applied to the oral airway. It works by pulling the soft palate and uvula forward against the base of the tongue and, in some patients, may pull the tongue forward a bit as well. This opens the pharyngeal airway to allow for unobstructed breathing during sleep. The one major study of this device, which will soon be in press in the journal Sleep Medicine, indicates that the device is successful (reducing the apnea hypopnea index (AHI) by >50% and yielding an AHI< 20) in about 41% of patients. Most successfully treated patients had an AHI

Phenotyping: This is not a therapy, but a way of approaching OSA patients that may lead to new therapies. Patients with OSA develop the disorder for quite different reasons with four primary physiologic traits dictating who does and does not have OSA. These traits are:

  • Upper airway anatomy/collapsibility.
  • Pharyngeal dilator muscle responsiveness during sleep (the upper airway response): The ability of these muscles to activate and dilate the airway during sleep.
  • The respiratory arousal threshold: The level of respiratory stimulation required to arouse the patient from sleep.
  • Loop gain: The stability or instability of the respiratory control system.

If the physician could determine exactly why each patient has OSA, therapy could be directed at the specific abnormality or abnormalities (from the list above). This could open up a number of new treatments individualized to the needs of the patient. Examples would include:

  • Hypnotics (sedatives) might be effective if the arousal threshold is low.
  • If loop gain is high, it could be reduced with oxygen or acetazolamid

The other therapies I am aware of that are in development are:

Surgically implantable devices : Several start-up companies over the last 5-10 years have attempted to develop a surgically implantable device primarily designed to manipulate tongue position. These devices would be attached to the mandible with a type of anchor in the body of the tongue such that the tongue could be pulled forward out of the pharyngeal airway. Several clinical trials were attempted with these devices with