2024-02-13 15:15:17
Sleep apnea is a pathology characterized by repeated episodes of upper airway obstruction during sleep. This causes the patient to wake up unconsciously and causes them to not rest, suffer from drowsiness during the day, and suffer from neuropsychiatric, metabolic, respiratory and cardiac disorders. Risk factors are obesity, aging or suffering from heart or kidney failure, among others. It causes a reduction in the quality of life, as well as a possible increase in high blood pressure, cardiovascular diseases and the risk of death.
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A modern surgical technique that is beginning to be used in many parts of the world to treat sleep apnea involves implanting a neurostimulator on the nerve that controls tongue movement. The neurostimulator prevents obstruction of the upper airway. Unlike other devices, the new one has no external indication that the patient is wearing it.
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This alternative is indicated for people with moderate or severe sleep apnea who do not tolerate standard treatment. It is estimated that they make up almost half of the patients diagnosed with this pathology.
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The Hospital del Mar is the first in Catalonia and one of the first in Spain to use this technology.
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The implantation of the neurostimulator on the nerve that controls the movement of the patients’ tongue is done with a minimally invasive surgical intervention, which allows offering an alternative for people who do not tolerate the standard treatment, CPAP (continuous positive pressure in the lungs). airways), a device that transmits pressure to the airway through a mask that must be worn during sleeping hours to ensure good breathing at night.
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Sleep apnea is a pathology with an increasing prevalence in Western countries, but it is underdiagnosed. In Spain, for example, it is estimated that there are between 1.2 and 2.1 million people who suffer from it, but less than 10% are diagnosed and under treatment. And in this group, almost half do not tolerate CPAP treatment. “These are patients who are not eligible for other sleep apnea treatments, to whom, until now, we could not offer any alternative if they could not tolerate the standard approach to apnea,” explains the head of the Otorhinolaryngology Service at Hospital del Mar, Dr. Jacinto García-Lorenzo. “Now, with this new alternative, we have a safe and effective long-term therapy to treat them,” he adds.
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The implantation of the neurostimulator is done thanks to an incision of only six centimeters under the patient’s jaw. It is intended to come into contact with the two branches, on each side of the tongue, of the hypoglossal nerve, which is the one that controls the genioglossus muscle, the largest muscle in the tongue. It is a latest generation device, Nyxoah-Genio, and it is the only one of its kind on the market that acts on both sides of the tongue. “It is a functional surgery of the upper airway, the objective of which is to increase the amount of air in the airway during sleep through the implantation of a neurostimulator that acts selectively on the fibers of the hypoglossal nerve, responsible for tongue movements,” explains Dr. Paula Mackers, associate physician at the Otorhinolaryngology Service, specialist in snoring and sleep apnea, and head of the project.
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The implantation of a neurostimulator on the nerve that controls the movement of the tongue prevents obstruction of the upper airway. (Photo: Hospital del Mar)
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Eight weeks after surgery the device is activated. From this moment on, the patient only has to put a sticker under the chin to hold the activation chip. “This stimulation causes the tongue muscles to contract, with the intention of keeping the airways open,” says Dr. García-Lorenzo. The activation only has to be carried out during sleeping hours and the patient does not show any external signs of the implantation of the equipment.
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The first surgeries were carried out on September 21 without any complications, in two patients, aged 52 and 67, with severe sleep apnea and for whom other therapeutic alternatives had not worked. Now the two treated patients have already activated the devices and have noticed an immediate improvement in the quality of their sleep. People with moderate and severe sleep apnea who pass the test (drug-induced sleep videosomnoscopy) that confirm their suitability to undergo the procedure and who meet the inclusion criteria may benefit.
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Dr. Núria Grau, coordinator of the Multidisciplinary Sleep Unit at Hospital del Mar, points out that the incorporation of this approach “is a very important step for the unit, since it incorporates a new therapeutic option. We have gone from treating practically all patients equally to be able to individualize and personalize which is the best therapeutic option for each patient. With this pioneering surgery we can offer an alternative treatment in those complex cases that do not tolerate the usual treatment and in those which we previously did not have alternatives, with the consequent health risk of having untreated nocturnal apneas. The use of this type of tools to treat sleep apnea, despite being quite new, has demonstrated its ability to improve patients’ respiratory parameters. (Source: Hospital del Mar)
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