A simple outpatient surgery is making a huge difference for one MUSC Health nurse’s quality of life.
Chris Long, R.N., didn’t realize he had sleep apnea until he switched to the day shift five years ago. But after starting each shift at 5:15 a.m., he found himself ready for a nap by 9 a.m. Visits with various doctors and a sleep study revealed he had sleep apnea, and he began using a continuous positive airway pressure machine, better known as a CPAP, to help him breathe at night.
After years of being tethered to the CPAP each night, Long was ready for a change. Luckily, he was already under the care of ear, nose and throat doctor Eric Lentsch, M.D., the only doctor in Charleston who implants the Inspire sleep therapy device.
“It’s essentially a pacemaker for patients with sleep apnea in an effort to open their airway during sleep,” Lentsch said.
Sleep apnea is a sleep disorder in which a person’s upper airway becomes blocked, reducing or stopping airflow. It interrupts the person’s sleep, but it can also increase the risk of a heart attack, stroke, certain cancers and diabetes.
MUSC was one of the study sites for the Inspire device trial. The initial one-year results showed a 78% reduction in sleep apnea events per hour, according to Inspire Medical Systems, a medical technology company that spun out of medical device leader Medtronic.
“It’s far and away the best surgical treatment we have for sleep apnea. CPAP remains the gold standard, and we all recognize that. But for people who can’t – and there is a large population who can’t tolerate CPAP – those patients can be very well served by the use of this device,” Lentsch said.
Long was one of them. Although the CPAP did help, it was also kind of an annoyance. The hoses have to be cleaned – either manually or with an expensive after-market system; there’s no such thing as an impromptu Saturday afternoon nap on the couch; and you have to lug the machine with you when you travel.
“I went on a cruise with it one time, and it was awful. Awful!” Long said.
And most importantly, the user might subconsciously remove the breathing mask in the middle of the night and not reap the machine’s benefits. Long estimated he would wear it for only four or five hours each night before taking it off in a sleepy daze.
The Inspire device, on the other hand, is permanently implanted in the user. During surgery, the doctor makes three 1-inch incisions – one below the jawline, another below the collarbone and the final between the ribs. The surgeon places a stimulation lead around the hypoglossal nerve, which controls tongue movements, then implants the generator below the collarbone and finally, places a sensing lead between the ribs.
The sensing lead senses when the user is about to take a breath and signals the stimulation lead to stimulate the hypoglossal nerve, which moves the tongue forward, forcing open the airway and allowing the user to breathe properly. “This happens within a split second,” Lentsch notes.
The patient can go home the same day. Thirty days after surgery, once the patient has fully healed, the device is activated, and the patient can begin using it at night. Just before bed, the patient turns the device on with a remote control. Inspire begins its work after a preset interval of time to allow the user to fall asleep – in Long’s case, that’s 20 minutes. His girlfriend has told him that now, his snoring stops as soon he hits that 20-minute mark. He’s even recorded himself and heard his snoring cut off mid-snore when the device turns on.
Lentsch said Inspire works very well for most users. “We’ve had very high success rates, maybe even surpassing the company’s,” he said.
Part of the reason for the high success rate is the screening that happens before surgery. Nurse practitioner Claire O’Bryan, part of the ENT team that handles Inspire surgeries, does an extensive workup of patients to determine if they would be good candidates for the surgery.
First, she said, the patient should have moderate to severe apnea. Second, the patient should have a body mass index of 35 or lower. Then, she talks to the patient about why he or she wants the surgery.
“We don’t want to implant anybody that is there just because they don’t like their CPAP. We don’t want to implant people that have unrealistic expectations,” she said.
Next, the surgical team looks at the patient’s throat anatomy in action to determine the pattern of how the airway collapses – the Inspire device works for a specific type of collapse, so patients must undergo a drug-induced sleep endoscopy to determine their suitability for the surgery, O’Bryan said.
The final step is getting insurance approval, which is getting easier.
“We’ve had a dramatic change in insurance coverage in the last six months,” O’Bryan said.
Long was watching the insurance situation closely. Eager for the surgery, he called everyone he could think of to encourage insurers to cover it – from human resources at MUSC to U.S. Sen. Lindsey Graham. In March, Blue Cross Blue Shield of South Carolina began covering the surgery, and on May 6, Lentsch implanted the Inspire device in Long.
Long is glad he had the surgery. He recommends it to anyone struggling with sleep apnea.
“It’s a totally different ballgame. I feel great during the day,” Long said. “I get a full night’s sleep, and I feel rested when I wake up.”