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New Therapies for Obstructive Sleep Apnea and Sleep Disorders

November 2017

Sleep disorders represent a serious health concern and contribute to or predispose individuals to conditions, such as type 2 diabetes mellitus, cardiovascular disease, obesity, and depression.1, 2, 3 While the average adult requires 7 or more hours of sleep each night1 and children and adolescents 8 to 10 hours2, nearly a third of adults and about 67% of U.S. high school students report getting less than the required amount.3 Adequate sleep improves overall health and performance, and it is estimated that insufficient sleep costs the U.S. $411 billion a year.4 The U.S. Institute of Medicine Committee on Sleep Medicine estimates that 50 to 70 million U.S. adults have sleep or wakefulness disorders. According to the American Academy of Sleep Medicine, more than 29 million adults have moderate to severe obstructive sleep apnea (OSA), with 80% being unaware and undiagnosed. Sleep apnea alone contributed more than $149.8 billion in healthcare and other costs in 2015.5

OSA arises from temporary closure of the pharynx during sleep, restricting air supply, interrupting sleep and making it less restorative. It can contribute to or exacerbate serious health problems. As with other common sleep disorders, including insomnia (difficulty in initiating or maintaining sleep), restless leg syndrome (“creeping” sensation in the legs that inhibits getting to sleep), and narcolepsy (excessive daytime sleepiness), OSA may have underlying physiological or comorbid causes, and treatment is important to avoid future health problems.6

Treatment of OSA depends on the cause and requires a multidisciplinary approach. Assessment begins with patients undergoing evaluation, which can include sleep studies that can often be done at home. Therapy may include management of medical conditions, devices, and surgery. One common device, a nasal continuous positive airway pressure device (CPAP), can help keep the airway open, allowing for restorative sleep.

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— Illustration of a placed upper airway stimulation therapy device and its function. Image courtesy of Inspire Medical Systems, Inc.

Not all patients, however, can tolerate or are candidates for CPAP, and adequate adherence to the treatment regimen remains a challenge for some. These patients may require other treatments, such as oral devices, surgical procedures, or neurostimulatory devices.

For patients with moderate to severe OSA who are unable to use CPAP, upper airway stimulation therapy via device implantation represents an alternative. The device stimulates the patient’s hypoglossal nerve during sleep, working in synchronization with the patient’s inspiration. The contraction of upper airway muscles pulls the base of the tongue forward and keeps the airway open, allowing uninterrupted sleep.

The University of Minnesota Health sleep health program was among the first in the Twin Cities metro area to implant the device. (See case study for further discussion.) The program has helped guide national direction in clinical care for patients with sleep apnea and pioneered use of additional therapies. Clinical care and discovery at University of Minnesota is helping to optimize sleep health in adults and children, including in the effective treatment of sleep-related disorders, insomnia, restless leg syndrome, and parasomnias.

When to refer

University of Minnesota Health sleep specialists provide comprehensive, coordinated care for sleep disorders, including sleep apnea, insomnia, narcolepsy, pediatric sleep apnea, and restless leg syndrome, among others. Our team includes surgeons, neurologists, otolaryngologists, pulmonologists, and sleep medicine physicians. Physicians employ an array of treatment options to improve overall sleep health and can offer patients access to clinical trials. Located across the Twin Cities metro area, our sites provide sleep observation units and integrated teams of sleep specialists, nurses, and nurse practitioners.

Our program was the first in the world to integrate home devices with patient electronic health records to provide daily monitoring and coordinated care for more than 9,000 patients who have sleep apnea in Minnesota. The program has assisted in developing national directions in clinical care for sleep apnea. Our physicians have also developed an Internet-based program for diagnosing common sleep problems and for assisting patients and their physicians in the initial steps in managing insomnia and sleep apnea. In additionto offering traditional treatments such as continuous positive airway pressure (CPAP) therapy, we also offer other therapies for patients unable to tolerate orunwilling to use CPAP. These include Inspire therapy, treatment with an implanted nerve stimulation device that has recently been approved for the treatment of obstructive sleep apnea.

Patient assessment entails a consultation with a sleep specialist who reviews the patient’s sleep habits and may recommend that the patient keep a sleep diary or wear a home monitoring device while sleeping. Physicians may recommend a sleep study for selected patients. Patients who do not have serious medical conditions and report loud snoring and interrupted breathing at night and daytime fatigue may be candidates for a home sleep test for sleep apnea. We also offer an online screening tool for patients.

References

  1. Watson NF, Badr MS, Belenky G, et al. Consensus Conference Panel. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep. 2015;38:1161-1183
  2. Paruthi S, Brooks LJ, D’Ambrusio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785-786.
  3. Wheaton AG, Olsen EO, Miller GF, Croft JB. Sleep duration and injury-related risk behaviors among high school students—United States, 2007-2013. MMWR Morb Mortal Wkly Rep. 2016;65:347-341.
  4. Hafner M, Stepanek M, Taylor J, Troxel WM, Van Stolk C. Why Sleep Matters: The Economic Costs of Insufficient Sleep. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_briefs/RB9962.html.
  5. Shokoueinejad M, Fernandez C, Carrol E, Wang F, Levin J, Rusk S, et al. Sleep apnea: a review of diagnostic sensors, algorithms, and therapies. Physiol Meas. 2017;38(9):R204-R252.
  6. Monderer R, Ahmed IM, Thorpy M. Evaluation of the sleepy patient: differential diagnosis. Sleep Med Clin. 2017 Sept;12(3):301-312.
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