As a dentist involved in helping patients with their snoring and obstructive sleep apnea, my biggest challenge has been figuring out strategies to keep the tongue from falling back into the oropharyngeal region. Once this happens, airflow is compromised, leading to diminished levels of oxygen in the blood and frequent arousals while sleeping.
As a result, these patients never feel rested, experience daytime sleepiness, and often underperform at school or in the workplace. Others develop significant heart-related problems or even fall asleep behind the wheel with tragic outcomes. Moreover, for patients who have small lower jaw, large tonsils, fat uvulas, and long sloping and floppy soft palates: nighttime airway compromise is a big problem (even if tongue size is normal!). For obese patients with large necks, fat tongues, and weak tongue muscle strength, the problem is further compounded.
Treatment over the years has included weight loss, airway surgery, CPAP (essentially blowing air thru the obstruction), and oral oral devices to prevent the tongue from falling backwards while sleeping (tongue retaining devices) or designed to actively keep the jaw forward, carrying the tongue in the process (mandibular positioning devices). Tongue retaining devices that pull the tongue forward past the lips have also been used with variable levels of success.
On the horizon, however, is a new kind of implant that may be an alternative treatment option for those with obstructive sleep apnea. As reported in the January 9th issue of the New England Journal of Medicine this implant will serve as a pacemaker of sorts, delivering electrical impulses to the nerve that is responsible for maintaining tone in the muscles that keep the tongue in a forward posture.
Tests conducted to date found that “these impulses reduced nightly sleep apnea events by about 68 percent, according to the results of the one year clinical trial. The technology also decreased by 70 percent the number of times that a person’s blood oxygen level dropped due to sleep apnea. Not surprisingly, patients reported a 40 percent improvement in their ability to stay awake during the day.”
According to new reports that reference the Journal article “the device operates by having an electrode run from the pacemaker to the hypoglossal nerve located under the tongue. Another lead wire runs down to the muscles between the ribs of the chest and keeps track of the person’s breathing. As the patient breathes in and out, the pacemaker sends electrical impulses to the nerve, which causes the person’s tongue to move slightly forward and their upper airway to contract open. Both movements keep the airway from collapsing.”
“It’s a unique and promising new treatment,” said study co-author Dr. Ryan Soose, director of the division of sleep surgery of Pittsburg Medical Center. The surgery is minimally invasive, and patients typically were back to regular activity within in a day or two.”
Though more research is needed, this new option will be a welcome addition to the treatment options that are currently available.