May 27, 2014 > Innovative Implant Offers New Sleep Apnea Therapy
Innovative Implant Offers New Sleep Apnea Therapy
Washington Hospital Physician Invents One of Implant Components
At the end of his annual physical exam nine months ago, David DowdÕs doctor asked him if he had any additional problems heÕd like to discuss. Mr. Dowd said, ÒNo,Ó but his wife said, ÒYes. He has a horrible snoring problem.Ó
ÒI thought I was sleeping fine, and I didnÕt realize my snoring was so loud, because I couldnÕt hear myself snore when I was asleep,Ó Mr. Dowd says. ÒSo I went into a sleep lab for testing, and they told me that I stopped breathing 55 times an hour, which means I had severe sleep apnea.Ó
ÒPeople who have sleep apnea have pauses in their breathing while they sleep,Ó says Dr. Jason Van Tassel, an otolaryngology (ear, nose and throat) physician with Washington Township Medical Group who treats many patients with sleep apnea. ÒCommon symptoms of sleep apnea include loud snoring, frequent awakenings and daytime fatigue. Other signs of sleep apnea might include morning headaches and dry throat, an inability to concentrate and feelings of irritability or depression.Ó
The most common type of sleep apnea is ÒobstructiveÓ sleep apnea, in which the airway collapses or is blocked during sleep. Any air that squeezes past the blockage can cause the loud snoring. Since sleep apnea occurs only during sleep, most people who have the condition arenÕt aware of it. ItÕs often the case that a family member or bed partner is the first person to note the loud snoring that can be a sign of sleep apnea.
In addition to resulting in daytime fatigue, untreated sleep apnea can lead to more serious complications, including high blood pressure, heart attack, stroke and irregular heartbeats. It also can increase your risk for obesity and diabetes.
The most common treatment for moderate to severe sleep apnea is a continuous positive airway pressure (CPAP) mask that fits over the nose or the nose and mouth and gently blows air into the throat. Unfortunately, many patients find the CPAP mask too uncomfortable or too noisy to wear. In those cases, surgery may be required.
ÒYears ago, the surgical treatments for sleep apnea worked only about half of the time,Ó says Dr. Van Tassel. ÒThere have been some dramatic improvements in sleep apnea therapy lately, however, and we now have procedures that work very effectively.Ó
One very recent advance in treating sleep apnea was approved by the U.S. Food and Drug Administration (FDA) in March Ð a minimally invasive surgical implant procedure that holds up the ÒhyoidÓ bone in the neck, which attaches to various muscles. The position of the hyoid affects the soft tissues in the soft palate and throat. Suspending the hyoid to move it forward tightens up those soft tissues so they donÕt block the airway during sleep.
ÒThe former surgical method for suspending the hyoid was not a minimally invasive procedure, and the implant was not adjustable,Ó Dr. Van Tassel notes. ÒI had performed the previous surgery for many years, but I just knew it had to be easier. It required multiple passes of suture around the hyoid bone and using large knots in the suture to fix the amount of tension in the suspension.Ó
Hyoid suspension with the new Encore System, developed by Siesta Medical in Los Gatos, requires only one pass of suture around the hyoid bone. It allows the doctor to optimize and adjust the tension during and after the procedure without the need to tie knots. The procedure uses one small incision, versus two larger ones. The former procedure used to take about two hours and required a two- to three-day hospital stay. The new procedure takes less than an hour and can be performed as an outpatient procedure or in a hospital with a one-night stay.
Dr. Van Tassel worked with Siesta Medical on the new implant procedure, developing the single-pass, knotless suture for better hyoid placement. He also collected clinical evidence that supported FDA approval of the new implant procedure, performing it on various patients who had difficulty using CPAP therapy for sleep apnea.
One of those patients was Mr. Dowd. As a surgical technician in the Washington Outpatient Surgery Center, he had worked with Dr. Van Tassel for many years and observed him perform surgery many times.
ÒI had tried using the CPAP mask, but I could only handle it for about four nights,Ó Mr. Dowd recalls. ÒIt was just too uncomfortable, and I couldnÕt sleep with it on. I thought this new implant might be a better solution for me than the CPAP.
ÒI knew Dr. Van Tassel is very good at what he does, and I absolutely trusted him,Ó Mr. Dowd adds. ÒI had the surgery five months ago at the Washington Outpatient Surgery Center, with a 24-hour stay in the upstairs recovery area where the nurses monitored my breathing and made sure there was no bleeding. For the first week after surgery, it was a little painful and a little difficult to swallow, but IÕve had no problems since then.Ó
Dr. Van Tassel notes that clinical evidence shows a 78 percent reduction in sleep apnea symptoms with the new procedure. The previous surgical technique for hyoid suspension showed improvements of only 40 to 50 percent.
ÒThis new implant procedure can be a good treatment option for sleep apnea patients who donÕt tolerate CPAP therapy well,Ó says Dr. Van Tassel. ÒBecause the CPAP mask is cumbersome and annoying, compliance with CPAP therapy is very low. Probably 70 percent of people who use a CPAP mask donÕt use it consistently.Ó
ÒAfter having this surgery, I was tested again for sleep apnea, and the testing showed I stopped breathing only four times an hour, down from 55 times an hour before the surgery,Ó Mr. Dowd says. ÒI didnÕt realize how much the sleep apnea had affected me. I have a lot more energy, and I feel rested when I wake up in the morning.
ÒMy wife of 25 years said that she couldnÕt sleep for the first few nights after the surgery because she couldnÕt hear me snoring, and it made her nervous,Ó he chuckles. ÒNow she loves the fact that IÕm not snoring, and sheÕs more rested, too. This procedure really does change things. Dr. Van Tassel said it would help, and he was right!Ó
Learn More Online
To find an otolaryngology (ear, nose and throat) physician close to you, visit www.whhs.com. To learn more about Washington Township Medical Foundation, visit www.mywtmf.com.
Tri-City Voice article re: sleep apnea implant