The Inspire implant has been shown to improve sleepiness and functional outcomes. Now researchers are looking at whether it also helps with comorbid disorders, such as insomnia and depression.

By Lisa Spear

When you have a tricky obstructive sleep apnea (OSA) patient who just can’t seem to tolerate CPAP, when adjusting the airflow pressure doesn’t seem to help, and when oral appliances aren’t successful at decreasing the patient’s apneas throughout the night; you might think about adding another method to your toolbox. Upper airway stimulation is still relatively new, but more research is coming out to show how this therapy could be an alternative treatment when CPAP fails.

According to an abstract that will be presented at the American Academy of Neurology (AAN) meeting in May, upper airway stimulation could also be effective at decreasing some comorbidities, including insomnia and depression.

“We showed clinically meaningful, significant improvement in people’s lives, that, you know, don’t always get looked at,” says Tina Waters, MD, a coauthor of the research and a neurologist sleep specialist at the Cleveland Clinic in Cleveland, Ohio.

According to Waters, demonstrating that upper airway stimulation for OSA reduces insomnia and depression is not necessarily surprising. But studies like this one are still important to substantiate that upper airway stimulation measures up to other OSA treatments.

The upper airway stimulation therapy analyzed in this study is sold under the brand name Inspire . It was approved by the US Food and Drug Administration in 2014 and has recently gained some traction with third party payors. More research looking at the benefits of this therapy could lead to more insurance coverage, says Waters.

By submitting this abstract to the AAN meeting, Waters hopes to raise awareness among the neurology community about the potential benefits of upper airway stimulation, which is a surgically-implanted system that stimulates key muscles that keep the airways open during sleep. “I thought this would be good to submit and get a different population excited about this,” she says.

To conduct their research, Waters and a team of clinical investigators analyzed polysomnographic data from OSA patients who were being treated with upper airway stimulation from November 2015 to September 2018. They observed trends in the patients’ apnea hypopnea index, arousal index, and oxygen saturation.

They also asked the study participants to take a number of surveys and questionnaires to better understand their condition. To rate their feelings of tiredness throughout the day, the participants filled out the Epworth Sleepiness Scale. The subjects were also asked to describe how much trouble they have falling asleep using the Insomnia Severity Index.

According to Waters, since upper airway stimulation is still so new, there remain a number of potential research questions to explore. For instance, clinical investigators have yet to explain how this method may reduce other OSA comorbidities, including diabetes and high blood pressure.

“CPAP is still considered the gold standard of care for obstructive sleep apnea, but if you are looking for alternative treatments, the more research that you can find that supports the therapy in a positive manner [will] further support the use of this therapy in the future,” says Waters.

Lisa Spear is associate editor of Sleep Review.