Dr Krishna Sundar: Several New Treatments Are Emerging for Sleep Apneas

New devices, both implantable and external, can help to manage sleep apneas, but underlying conditions must also be treated, which can improve symptoms, too, explained Krishna M. Sundar, MD, clinical professor, Pulmonary Division, Department of Medicine, and medical director, Sleep-Wake Center, University of Utah.

Transcript

What are the standard treatments for obstructive and central sleep apnea? Are there new developments?

So in obstructive sleep apnea, the standard therapy is CPAP, or continuous positive airway pressure therapy, which most are familiar with. We also are understanding that the nature of central sleep apnea is different from person to person and we need to personalize our approaches. So again, weight loss is important, as I talked about BMI [body mass index] is one of the major drivers of obstructive sleep apnea.

Finally, the tongue is one of the major muscles which can flop back at night. So we have something called a hypoglossal nerve stimulator now, which is like a pacemaker, which stimulates the nerve each time you breathe in so that the tongue moves out of the way with each breath. So that's now very well validated. We have data [on] up to 7 to 10 years of use in patients that have been implanted this device. And then finally, we have something called a mandibular advancement device, which is a dental appliance which pulls the lower jaw forward.

So, that's all in terms of the obstructive sleep apnea space, in terms of various treatments. Again, the most recent is the hypoglossal nerve stimulator, which more and more patients are getting implanted.

So for central sleep apnea, again, we need to understand why it occurs, and often if it occurs in the setting of sleep apnea, we need to treat obstructive sleep apnea first and see how the central sleep apnea evolves. In a substantial chunk of these patients, central sleep apnea actually resolves.

But when they have underlying heart failure and other conditions, it's important to treat those conditions as best as possible, because that can also improve the symptoms. So central sleep apnea always occurs in the background of something else, which may contribute to more problems to the stability or control of breathing at night. And heart failure is one of them.

And then we have a device called adaptive server ventilation, which is like a CPAP, but it actually tries to breathe during the time when somebody is having a pause in breathing from a central sleep apnea. So even though it's being used quite a bit, one of the problems is it cannot be used in patients with heart failure, because in a big study it was shown to cause increased mortality. It cannot be used in patients with low ejection fraction. So there is a new phrenic nerve stimulator. This is a nerve stimulator, which stimulates the nerve going into the diaphragm, just now FDA approved. This is placed by an electrophysiologist, which is being increasingly being done in patients with persistent central sleep apnea.