Tongue pacemaker can defeat snoring

Sleep apnea therapy: tongue pacemaker against snoring

05/28/2014

Snoring is not only annoying for those affected, but can also be dangerous. Many people gasp for breath without knowing it. A novel pacemaker for the tongue can help, but only for some sleep apnea patients.

Snoring can be dangerous

Many people gasp for breath without knowing anything about it. Those who struggle with tiredness, circulatory weakness, or headaches during the day despite regular sleep may suffer from Obstructive Sleep Apnea (OSA). As a result, the tongue sags back into the throat during sleep because of the loosening muscles and blocks the upper respiratory tract. This leads to snoring and breathing pauses until stress hormones arouse the body due to the lack of oxygen. The constantly recurring oxygen deficiency damages the blood vessels in the medium term and can lead to hypertension. The risk of heart attack and stroke increase, the risk of accidents increases. About five to ten percent of the population should be struggling for air at night. Especially overweight men in middle age are affected.

Tongue pacemaker only for a small part of those affected

For a small part of those affected, a tongue pacemaker („Upper Airway Stimulation“), which stimulates the mechanics of the respiratory process, provide medical remedies. The device, which is implanted under the collarbone, uses a sensor to measure the pressure of the lungs between the ribs, and shortly before inhaling it sends a signal via cable to a cranial nerve under the tongue. The electrical impulse was only slightly or not noticeable to the patient. These „mild stimulation“ prevents the relaxation of the muscles. „As a result, the patient breathes regularly during sleep“, Joachim Maurer from the University ENT Clinic Mannheim. Doctors have been testing the technology on patients for several years. According to Maurer, only one to two percent of them are currently eligible.

Many patients have not been treated yet

At the beginning of the annual meeting of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO KHC), he presented in Dortmund on Tuesday the first major international study on the efficacy of treatment. The results of the investigation were also in the journal „New England Journal of Medicine“ released. Thus, pacemaker pacemaker drops 68 percent in specially selected patients and 70 percent decreases in oxygen in the blood. The daytime sleepiness decreases and the quality of life improves. Maurer explained: „Almost half of all patients have not been treated adequately or have not been treated at all.“ The reason for this is that the previously used therapy with nocturnal breathing masks („Continuous Positive Airway Pressure“) helps many patients, but for some the procedure is so uncomfortable that the devices often disappear in the closet.

Immense and expensive intervention

In the study, a total of 124 patients were treated internationally, including in Germany, Russia and the United States. Maurer sums up the results of the study: „In 70 percent, the treatment shows just as good a result as the respiratory masks, in 20 percent shows improvement, which is still optimizable - in only ten percent of patients, the treatment does not suggest.“ However, those affected by the General Association for Chronic Sleep Disorders Germany (AVSD) are still skeptical. „This is an immense invasion of the body and extremely expensive - although it is unclear whether the health insurance will ever pay the treatment“, said Hartmut Rentmeister, board member of the association representing 4,000 self-help patients. Per treatment, the cost is estimated at about 20,000 euros. „In addition, the device can only be used in a specific patient group“, so Rentmeister.

Many exclusion criteria for the tongue pacemaker

Maurer also acknowledged that only a few affected people can be treated with the tongue pacemaker. Although obstructive sleep apnea is one of the most prevalent conditions in sleep-disordered breathing, therapy is only available to patients who would not tolerate standard therapies such as respiratory masks or jaw splints. In addition, there are other possible exclusion criteria, such as too much almonds, too small jaws or heart failure. Patients should also have no lung disease, no pacemaker and excessive overweight (obesity). In addition, the central sleep apnea, in which the respiratory center is affected, also not treatable in this way. Although a meticulous preselection of patients is responsible for the good results of the study, Maurer is optimistic that as research progresses, more patients will soon be eligible for treatment, potentially reducing costs in the longer term. The cost transfer is currently bound by the statutory health insurance but still to the participation in further studies. (Sb)