Inspire Medical’s Upper Airway Stimulation therapy is a treatment option for many patients with obstructive sleep apnea who do not tolerate positive airway pressure therapy (for example, CPAP). There are a few steps to determining whether a patient is a good candidate, including performing drug-induced sleep endoscopy (DISE). If you are interested in more background on DISE, I have posted two videos on Youtube that explain DISE and present examples of DISE videos.
The STAR Trial was the major study showing Upper Airway Stimulation treated obstructive sleep apnea well, and all individuals in the study underwent DISE to make sure they did not have a specific DISE finding called complete concentric collapse related to the soft palate that is seen in about 1/3 of all patients with obstructive sleep apnea. It is not entirely clear why some individuals have this finding, although my own experience is that it is more likely with weight gain or enlarged tonsils. The important thing for patients considering Upper Airway Stimulation is that you would not be considered a good candidate.
What if you have this finding but still are interested in Upper Airway Stimulation?
Dr. Armin Steffen and colleagues at the University of Lubeck in Germany examined this question in a study published last year in the journal Sleep and Breathing. In a series of 14 individuals, he performed tonsillectomy with soft palate surgery using a conservative technique. The study included individuals who still had their tonsils, with moderate to severe obstructive sleep apnea (average apnea-hypopnea index 35), and who were in the overweight/obese range (body mass index 24-40 kg/m2). They compared DISE findings before and after surgery and showed that after soft palate surgery almost all of them (13/14) no longer had this finding of complete concentric collapse related to the soft palate.
What does this mean for patients?
If you have complete concentric collapse related to the soft palate, then you would not undergo implantation of the Upper Airway Stimulation system directly. However, other treatments such as soft palate surgery with tonsillectomy can be used to resolve the complete concentric collapse. If the soft palate surgery did address the complete concentric collapse but did not clear up the obstructive sleep apnea, then patients could be candidates for other treatments such as Upper Airway Stimulation. About 4 years ago, I performed soft palate surgery in exactly this scenario (complete concentric collapse and interested in Upper Airway Stimulation after soft palate surgery). He ended up achieving some really nice results with the soft palate surgery, feeling so much better that he was able to exercise more and lose weight, clearing up his sleep apnea without needing any other treatments.