Sleep apnea surgery has been the focus of my entire career, now spanning over 20 years since completing all my training. Given that I have entered what I would consider the middle stage of a sleep apnea surgery career, I am increasingly being asked to give talks reflecting on the journey that has occurred in the field of sleep apnea surgery. Maybe I am getting older than I like to admit!

I always start these talks by explaining that one key factor in my decision to enter sleep surgery was the idea that this was a new field with many unanswered questions and a need for more sleep apnea surgery research.  There was so much to learn about sleep apnea surgery, and I wanted to be part of helping advance the field through high-quality research related to sleep apnea surgery. After all these years, performing research has allowed me to improve the results in sleep apnea surgery in my own patients and to share these advances with other surgeons.

Currently I perform a wide range of sleep apnea surgery research studies that I describe on the Research page of my main website.  Here I want to write about major ongoing sleep apnea surgery research studies in which I include my own patients.  These studies do not cover the major costs of medical care, for example the costs of surgery, but there are some tests that may be included.

Sleep apnea surgery evaluation: DISE

If I had to pick one specific sleep apnea surgery research area on which I have devoted the most time, it would be improving patient evaluation to make sleep apnea surgery more targeted and effective.  Basically, many surgeons have learned to do a single procedure to treat all patients with sleep apnea the same way.  Unfortunately, sleep apnea surgery is not so simple.  Different patients have different causes of their sleep apnea, and getting the best results depends on determining the causes to treat patients appropriately.

Drug-induced sleep endoscopy is a surgical evaluation technique for that involves sedation to reproduce the blockage in breathing that occurs during natural sleep.  My drug-induced sleep endoscopy research examines the findings and results in my own patients, starting from the drug-induced sleep endoscopy itself, the sleep apnea surgery that I perform, and the results of sleep apnea surgery.  I have published a number of studies focused on my own patients, but we have also led international cohort studies related to drug-induced sleep endoscopy and sleep apnea surgery results. These have shown important associations between findings of drug-induced sleep endoscopy and the results of traditional sleep apnea surgery and Inspire Upper Airway Stimulation. Beyond these initial studies, we have extended the work to show how evaluating the bony and muscle anatomy of the palate (roof of the mouth) can add to drug-induced sleep endoscopy in improving decision making and results for traditional sleep apnea surgery and Inspire Upper Airway Stimulation.

Sleep Apnea Surgery: Hypoglossal Nerve Stimulation

We have entered a new era in sleep apnea surgery, one of neurostimulation. Three different technologies now offer stimulation of the hypoglossal nerve, the nerve that controls movement of the tongue: Upper Airway Stimulation from Inspire Medical Systems, Genio from Nyxoah, and aura6000 from LivaNova (FDA-approved but expected United States commercial launch in 2027).

Inspire Medical’s Upper Airway Stimulation system was one of the most exciting recent breakthroughs in the treatment of obstructive sleep apnea, certainly in obstructive sleep apnea surgery.  I was the first surgeon in the western United States to offer this therapy after FDA approval in 2014.  My continued enthusiasm for Upper Airway Stimulation as an important sleep apnea surgery treatment is based on the excellent results I have seen in my patients. I believe that these results, like those for patients treated with othertypes of sleep apnea surgery, reflect a combination of:

• the Upper Airway Stimulation technology and the support of Inspire Medical personnel
• careful selection of appropriate patients, relying heavily on our experience and expertise with drug-induced sleep endoscopy
• shared commitment to patient care from the entire surgical and sleep medicine teams

I have been fortunate to work with many established and startup medical device companies during my career as a leader in sleep apnea surgery. I worked as a consultant for Nyxoah for a decade, during which I was on the scientific advisory board and then transitioned to a consultant role, examining drug-induced sleep endoscopy videos that were part of their sleep apnea surgery clinical trials. I was not an engineer working on the development of their Genio system, but I was a coauthor of their DREAM study that formed the basis for their FDA approval in August 2025. We have started our Genio program here at UCLA based on our belief that it offers has a different risk-benefit profile than the Inspire system, with further research and careful evaluation of outcomes the key to understanding this more clearly. We plan to apply the same rigorous approach in caring for patients treated with the Nyxoah Genios system, and I look forward to sharing my sleep apnea surgery results and those of other centers going forward.

 

Combining Medications with Sleep Apnea Surgery

I have written previously about my sleep apnea surgery clinical trial funded by the National Institutes of Health. More information can also be found on the UCLA Health Clinical Trials website or ClinicalTrials.gov. The short explanation is that the most important cause of obstructive sleep apnea is the physical blockage of breathing, also called anatomy. This is what we treat with sleep apnea surgery. That being said, other factors may also contribute to obstructive sleep apnea, factors that can be treated with medications but not sleep apnea surgery. The two most important additional causes of obstructive sleep apnea are related to the control of breathing and the arousal threshold. Our clinical trial is enrolling patients undergoing sleep apnea surgery, evaluating them before and after surgery with specialized in-laboratory sleep studies. If study participants do not do as well as we would like with sleep apnea surgery alone, then they can be treated with medications designed to improve their obstructive sleep apnea above and beyond what sleep apnea surgery achieved. We are in the midst of this sleep apnea surgery and medications trial, and interested individuals or providers should reach out to me for more information.

Snoring and sleep apnea surgery research brings the same excitement and challenges for me today as it did many years ago.  We have made substantial advances in snoring and sleep apnea surgery, and patients have seen the benefits of this work.  Surgeons have a responsibility to participate in research to move the field of sleep apnea surgery forward and continue the progress that has been made.  Good research creates new questions, so there should be no shortage of interesting and important studies.