When I chose to focus my career on snoring and sleep apnea surgery, one key factor in my decision 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 when it came to surgery for snoring and obstructive sleep apnea, and I wanted to be part of helping these patients through high-quality research. Fifteen years later, performing research has allowed me to improve the results for sleep apnea and snoring surgery in my own patients and to share these advances with other surgeons.
Currently I perform a wide range of research studies that I describe on the Research page of my main website. Here I want to write about 3 major research areas of sleep apnea surgery research 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 and MRI
Throughout my entire career, the primary focus of my research has been improving patient evaluation to make 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 surgery that I perform, and the results of surgery. I have published a number of studies focused on my own patients, but we are leading an international effort through the International Surgical Sleep Society that will allow us to evaluate more-detailed questions related drug-induced sleep endoscopy.
The USC Viterbi School of Engineering at the University of Southern California is one of top engineering schools in the world. We are fortunate that there are some faculty with a dedicated interest in sleep apnea, and in fact we have formed a collaborative effort named Sleep Health Using Bioengineering (SleepHuB). Working with these engineers has enabled many new research directions, and one of these is the use of magnetic resonance imaging (MRI). Working with USC engineer Krishna Nayak, PhD and sleep medicine physician and MRI researcher Richard Schwab, MD from the University of Pennsylvania, we are studying specialized MRI research protocols for their potential role in guiding sleep apnea surgery and predicting surgery results.
Inspire Medical’s Upper Airway Stimulation
Inspire Medical’s Upper Airway Stimulation system remains one of the most exciting recent breakthroughs in the treatment of obstructive sleep apnea. We at Keck Medicine of USC were the first center in the western United States to offer this therapy. Our continued enthusiasm for Upper Airway Stimulation as an important sleep apnea treatment is based on the excellent results we have seen in our patients. We believe that our results reflect the 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
With this foundation to deliver the best results for patients, we are one of just a few centers in the country that are part of two studies supported by Inspire Medical. The first study is what is called a post-FDA approval study. Inspire Medical was asked to conduct this study as part of the approval for sale in the United States. The purpose is to evaluate the results in patients receiving the treatment after approval, just to confirm that the excellent results of their STAR Trial remain consistent in another group of patients. The second study is a registry study that looks at all patients who have received the device, without the same number of sleep studies and other evaluations that are part of the post-FDA approval study.
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 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.