Hospital del Mar, in Barcelona, ??is the first public center in Catalonia and one of the pioneers in Spain to try a surgery to treat sleep apnea that consists of implanting a neurostimulator under the chin that controls the movement of the patient’s tongue and prevents airway obstruction while sleeping.
The procedure, quite experienced in countries such as the United States, Germany or Belgium, is indicated for people who do not tolerate the standard treatment, CPAP, continuous positive pressure in the airways through the introduction of air, the typical connected mask to a machine There are also oral devices or surgeries such as uvulopalatopharyngoplasty (removal of excess neck tissue to widen the airway).
Nothing was working for 53-year-old Juan Carlos Pose. He was doing 40 apneas per hour, when the maximum level would be 15, and was treated with CPAP. “Straps on your face, the flexible tube that makes noise when you wiggle… it’s tremendously uncomfortable. And it’s even more so when it’s hot, and you have to take the machine with you if you’re going on a trip,” he explains. He did not tolerate discomfort and used any excuse to avoid wearing the mask, he admits. Alternatively, they proposed placing a mouth splint that moves the jaw forward during sleep to open the airways. It wasn’t that uncomfortable, but it was less effective than the mask.
When Paula Mackers, specialist in snoring and obstructive sleep apnea at the Hospital del Mar, proposed the implantation of a neurostimulator, she ended up accepting it: “It seemed the least invasive, the most comfortable. I knew absolutely nothing about this, and I won’t deny that I had suspicions, but not because I felt like a guinea pig, because it is done in other countries and it had already been done in Spain in private healthcare” .
Sleep apnea is a very prevalent disease, increasingly so, in Western countries, but it is underdiagnosed. It is estimated that there are between 1.2 and 2.1 million people in Spain, but less than 10% have been diagnosed and are receiving treatment. “These are repetitive episodes of obstruction and closure of the upper airway during sleep, with which oxygen levels repeatedly drop. In the long term, there are significant sequelae, especially cardiovascular, with a risk of premature death or heart attack,” says Dr. Mackers. More than 30 apneas per hour is considered a severe level. Between 15 and 30, moderate. In both cases the first line of treatment is CPAP. “The problem is that the mask has a very low compliance and adherence rate and a very high rejection rate. Between 40% and 70% of patients do not comply with treatment. They must have an alternative therapy”, he clarifies.
This alternative comes with high technology. It consists of the implantation of a neurostimulator through a 6 cm incision below the chin. The device is placed in contact with the hypoglossal nerve, which stimulates tongue movement. It is activated every night before sleep, has a breathing sensor, and every time the patient breathes in, the device sends an electrical impulse to the tongue and the latter contracts to open the airway.
Eight weeks after the surgery, which lasts about four hours and requires a night’s hospitalization, the neurostimulator is activated. Each night, when the patient goes to bed, the small activator chip (about the size of a button) will be attached under the chin with a dressing, which will be removed when he wakes up and left charging in the running until the next night.
Juan Carlos Pose tackles the last phase of the process: setting the intensity, frequency and start time of the electromagnetic impulses to adapt the operation of the device to his needs. The first two patients were operated on in September. The third intervention is now being prepared for a person who meets the criteria for inclusion in the program: having moderate or severe apnea, failing previous treatments and undergoing the drug-induced sleep video-somnoscopy test.
