Guy’s and St Thomas’ has become the first NHS trust in the UK to use a pioneering implant device to treat severe sleep apnoea. Hypoglossal nerve stimulation involves implanting an Inspire upper airway stimulation device under the skin in the chest with a lead that goes under the chin. The device delivers breath-synchronised mild stimulation to the hypoglossal nerve that controls the movement of the tongue and other key airway muscles, allowing the airway to stay open during sleep. It is controlled by a small handheld sleep remote, which the patient turns on before bed and off in the morning when they wake up.
The device is inserted under the skin on the chest wall in an hour-long operation and connected to a cable 2mm in diameter and 30cm long that is tunnelled under the skin and connected to the nerve that moves the tongue. The device works by stimulating the tongue muscle to contract forward and drawing the tongue out of the windpipe to allow normal airflow in and out of the lungs. Patients use a handheld controller the size of a computer mouse to turn the device on 30 minutes before they plan to sleep, and off again when they wake up.
Yakubu Karagama, a consultant ear, nose and throat surgeon at GSTT, has so far implanted the device in three people with obstructive sleep apnoea (OSA), and he explained that the device is most suitable for people diagnosed with moderate to severe OSA who cannot use a continuous positive airway pressure (Cpap) machine to assist their breathing overnight.
Matthias Winker, from Reading in Berkshire, suffered with severe sleep apnoea for more than four years and conventional treatments had failed to work.
“Without using a CPAP machine I was having over 40 episodes an hour and would stop breathing for up to 45 seconds at a time. This major disturbance in sleep meant I didn’t feel myself, and left me tired and with low energy throughout the day. The CPAP helped to mitigate the sleep apnoea but wearing a mask for the next four decades didn’t fill me with joy and is inconvenient when traveling. In the long term I was at higher risk of having a stroke and heart disease, and a generally poorer quality of life. My wife was really worried and encouraged me to look into other treatment options.”
He was one of the first patients to receive hypoglossal nerve stimulation at Guy’s and St Thomas’ to treat the condition.
“This therapy has been a tremendous success. I now only have two or three episodes per hour for a few seconds at a time, and then the device jumps in so I can breathe. It took some time to get used to but now it’s comfortable and doesn’t wake me up in the night.”
More than 25,000 implants have been fitted worldwide including in the USA, Germany, Netherlands and other European countries. So far three patients have had the device fitted at Guy’s and St Thomas’ and the Trust plans to offer the treatment to more people.
“Sleep is very important for physical and mental health and general wellbeing so it’s essential that we are able to help patients with sleep apnoea,” explained Karagama. “This treatment isn’t suitable for everyone and many people will benefit from proven, conventional treatments such as a CPAP machine. In a small group of patients who have moderate to severe sleep apnoea, where other treatments have failed, this new device could be a solution. I’m delighted that it is making a huge difference for our patients, and that Matthias has seen such positive results.”