How has sleep surgery changed over time? In this post, we discuss two key sources of change: drug-induced sleep endoscopy (DISE) and the Nyxoah Genio hypoglossal nerve stimulation system. DISE is a sleep apnea surgical evaluation that helps surgeons develop a targeted, effective plan, improving outcomes. It is recommended in many patients considering surgery, especially implantation of one of the available hypoglossal nerve stimulation systems. DISE is not new, but research performed over the years, including studies we have led, have changed how we make decisions about sleep apnea surgery.

DISE and sleep apnea surgery

Recently I had the opportunity to speak with Andrew McGinn, RPSGT, MSc Candidate on his YouTube channel: CPAP friend. Andrew is completing his MSc from the University of Oxford in Sleep Medicine and has shared his own experiences with obstructive sleep apnea and treatment, in addition to bringing in leading voices in sleep apnea. We spoke about DISE, and I truly enjoyed the conversation and DISE and sleep surgery. Andrew blends insight from his experience as a patient (treated with multiple approaches, including surgery) and registered polysomnographic technologist. In our discussion, I shared some DISE video samples, focusing on different patterns of collapse seen during DISE and their role in the selection of procedures. I also discussed our research related to DISE. You can watch the video below, although I have to laugh because the thumbnail includes a photo of me from younger days along with someone else’s hand holding up a video laryngoscope that I have not seen before.

DISE has propelled our field of sleep surgery forward, leading us to conduct some large research studies showing how surgery can achieve excellent results in certain types of patients but notably-worse results in others. I use the findings of this research based on DISE in discussions with patients considering sleep surgery on a daily basis.

We talked about the evolution in sleep surgery over my career, dating back to the seedlings of my interest in medical school. I was fortunate to train with a number of sleep surgery pioneers and leaders in the field: Ed Weaver, Richard Goode, Bob Riley, Nelson Powell, and Kasey Li. I also have been blessed to work with leaders in sleep medicine who understood the potential benefits of surgery in their patients who did not tolerate positive airway pressure therapy, including David White, Atul Malhotra, and many others. I have considered all of these people friends and colleagues and am so fortunate that they have treated me with such respect and support that continues today. It is an honor to have worked with them. I hope they share my enthusiasm for any contributions I have made or will make to the fields of sleep apnea and sleep surgery. Last week, I spoke at a sleep surgery conference at Stanford recognizing Richard Goode, and in June I will travel to Baltimore for a dinner honoring David White. The philosophy of “pay it forward” has encouraged me to provide the same support to others, especially those getting started on their own surgery careers. I love sharing what I have learned about what we do and do not know with others like Andrew committed to educating the public about sleep apnea and sleep surgery.

First Nyxoah Genio implants at UCLA

We have officially started the Nyxoah Genio implant program in UCLA Sleep Apnea Surgery! We have implanted our first 3 patients and are looking forward to their activation visits and monitoring their response to this treatment. We are partnering with our outstanding UCLA Sleep Medicine team, who will manage the patients primarily after they heal from their Genio implantation and perform the sleep studies that evaluate the results of this surgery.

Sleep surgery has undergone major changes over the span of my career, and hypoglossal nerve stimulation has been a major advance. Inspire Upper Airway Stimulation paved the way. I was the first surgeon in the Western US to offer Inspire therapy to patients after FDA approval in 2014. In August 2025, Nyxoah secured FDA approval for the Genio system. The UCLA Health team featured our Nyxoah program, and we are excited to move forward together with our patients. We will continue to contribute what we can to improving sleep apnea patient care through research and will examine Nyxoah Genio outcomes as we develop a larger number of patients undergoing this surgery.

Disclosure and opinion: I was a paid consultant for Nyxoah for over a decade, just like I have worked with a number of companies involved in sleep apnea. I believe in Nyxoah’s Genio technology and feel that my evaluation of it is independent of this previous relationship. Over time, we will learn more about what the Nyxoah Genio offers to patients considering surgery and in whom it works especially well. Ultimately, I believe that there is room for multiple hypoglossal nerve stimulation companies in sleep apnea, as I expect that the ideal patient population for each approach will be slightly different.