Tech & Innovation in Healthcare
Provide More Restful Sleep for Your OSA Patients With UAS
Clear the airway without constant air pressure. Obstructive sleep apnea (OSA) is the most common form of sleep apnea and can be treated with continuous airflow from an external machine. However, in recent years, researchers have discovered that by stimulating the tongue’s hypoglossal nerve while the patient sleeps, the tongue moves gently out of the way to free up the airway. Find out how you can treat sleep apnea without bulky equipment. Know How OSA Affects Your Patients Sleep apnea is a sleep disorder that can have potentially dangerous results depending on the severity of the condition. When a patient suffers from sleep apnea, their breathing periodically stops and starts, they may snore loudly, or they may gasp for air while sleeping. Most patients suffer from OSA, and several factors can contribute to the condition including hormonal changes, large tonsils, or obesity. Providers will perform a sleep study to evaluate the patient and diagnose them with OSA. After suggesting healthy lifestyle changes, a provider may prescribe a continuous positive air pressure (CPAP) machine that delivers constant air pressure to help keep the patient’s airway open when they inhale while sleeping. However, some patients don’t benefit from a CPAP machine, are unable to use the device, or simply fail CPAP treatment for several reasons. “People can have claustrophobia. Some people can’t stand the pressure. The masks leak no matter what mask [the patient] tries. Some people throw it off in the middle of the night without even knowing it — they wake up and it’s on the bedroom floor,” says Timothy Dettmer, MD, otolaryngologist at Mason City Clinic in Mason City, Iowa. When the CPAP is an ineffective treatment for OSA, the patient may be eligible for an upper airway stimulation (UAS) implant. What Is Upper Airway Stimulation? UAS — also known as hypoglossal nerve stimulation (HNS) — uses a medical device implanted in the patient’s chest with an electrode connected to the tongue’s hypoglossal nerve. “Hypoglossal nerve stimulation is a surgical procedure that assists patients with OSA,” said Michelle Mesley-Netoskie, COPM, CPC, CPB, COC, CRC, CPPM, CPMA, CPC-I, revenue cycle management specialist at Albany ENT & Allergy Services during AAPC’s “ENT Procedures, Surgeries and Other Hot Topics” webinar. The tongue is home to several muscles, including the genioglossus, styloglossus, and hyoglossus muscles, which are used to help the tongue retract and protrude. The hypoglossal nerve is a motor nerve in the tongue that activates the muscles, and allows the muscles to narrow, curve, and shorten the tongue. When a patient is asleep, the muscles and soft tissue in the tongue and throat area relax, which cause them to collapse on the throat and block airflow. With an implanted UAS device, the hypoglossal nerve is stimulated while the patient sleeps, causing the tongue to gently move forward away from the patient’s airway to enable proper airflow. Patients Don’t Have to Worry About Maintenance Unlike CPAP treatment, UAS doesn’t involve a lot of external equipment, which is beneficial to the provider and patients. Providers often see more patient compliance “because they’re not dealing with hoses and noisy machines,” Mesley-Netoskie said. The UAS device consists of four main components: 1. Generator: The generator is surgically implanted on the patient’s chest and uses battery power to transmit pulses to the stimulation electrode. 2. Breathing sensor lead: This electrode identifies the patient’s breathing pattern during sleep. 3. Stimulation lead: This electrode provides a gentle stimulus to the hypoglossal nerve. 4. Remote control: The patient turns the device on before sleep and turns the device off after waking up. Your patient will undergo an outpatient procedure under general anesthesia to implant the UAS device. With a few small incisions on the skin, the surgeon can implant the battery-operated generator and electrodes. The generator will be placed under the skin and soft tissue on the chest below the collar bone. The surgeon will place the breathing sensor electrode beneath rib cage. The surgeon will then wrap the stimulation electrode around the hypoglossal nerve, which is located under the jaw. At bedtime, the patient picks up the remote control and holds it to their chest near the pulse generator to activate the device. As the patient uses the device, the stimulation level can be adjusted to suit the patient’s needs and breathing patterns. Use RPM to Track the Efficacy of Your Patients’ UAS Devices One company that has developed UAS therapy is Inspire. Their UAS system received U.S. Food and Drug Administration (FDA) approval in 2020 for use with select patients diagnosed with moderate to severe OSA. Inspire also features software that allows healthcare providers to remotely monitor their patients’ sleep symptoms. The software offers automatic and wireless therapeutic monitoring, care coordination and collaboration, and engagement with patients through education, quality of life surveys, and therapy-related achievements. By using the software, providers can get an accurate picture of the patient’s sleep patterns in their natural setting versus in a sleep center. Evaluate UAS Therapy Efficacy Before Inspire received FDA approval, researchers performed several studies to examine the efficacy of UAS therapy on patients with OSA. In fact, researchers continue to evaluate UAS effectiveness for different patient populations diagnosed with OSA. For example, in a study published in JAMA Otolaryngology-Head & Neck Surgery in April 2022, researchers found that children and teens with Down syndrome and OSA experienced a reduction in apnea-hypopnea index (AHI) scores by over 50 percent over a 12-month period. While UAS has proven effective in reducing the number of OSA events during sleep, some researchers feel further testing may be helpful in assessing other comorbidities, treatment success, and ideal patient candidacy.
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