The Hospital del Mar, in Barcelona, ??is the first public center in Catalonia and one of the pioneers in Spain to adapt a surgery to treat sleep apnea that consists of the implantation of a neurostimulator under the chin that controls the movement of the patient’s tongue and prevents blocking the passage of air during sleep.
The procedure, widely 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 by introducing air, the typical mask connected to a machine. . There are also oral devices or surgeries such as uvolopalatopharyngoplasty (removal of excess throat tissue to widen the airway).
Nothing was working for Juan Carlos Pose, 53 years old. He had 40 apneas per hour, when the maximum level would be 15, and he was treated with CPAP. “Straps on the face, the flexible tube that bothers you when you move… it is tremendously uncomfortable. Even more so if it is hot, and you have to take the machine if you go on a trip,” he explains. He did not tolerate the discomfort and used any excuse to avoid putting on the mask, he admits. Alternatively, he was offered a splint in his mouth that advances his jaw during sleep to open his airways. It was less uncomfortable, but less effective than the mask in reducing the risk.
When Paula Mackers, a specialist in snoring and sleep apnea at the Hospital del Mar, proposed the implantation of a neurostimulator, he ended up accepting: “It seemed the least invasive, the most comfortable. I didn’t know absolutely anything about that, and I won’t deny that I had my suspicions, but not because I felt like a guinea pig, because it is done in other countries and had already been done in Spain in private healthcare.”
Sleep apnea is a very prevalent disease, increasingly in Western countries, but it is underdiagnosed. It is estimated that between 1.2 and 2.1 million people in Spain suffer from it, but less than 10% have been diagnosed and are undergoing treatment. “They 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 important consequences, especially cardiovascular, with the risk of premature death or heart attack,” says Dr. Mackers.
More than 30 apneas per hour is considered severe apnea. 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 have to have an alternative therapy,” he clarifies.
This alternative comes hand in hand with high technology. It consists of the implantation of a neurostimulator through a 6 cm incision under the chin. The device is placed in contact with the hypoglossal nerve, which stimulates tongue movement. It is activated every night before going to sleep, it has a breathing sensor, and every time the patient breathes in, it sends an electrical impulse to the tongue and it moves to open the airway and prevent collapse, allowing the patient to breathe. .
Eight weeks after surgery, which lasts about 4 hours and requires overnight hospitalization, the neurostimulator is activated. Every night, when going to bed, the patient must stick a dressing, under the chin, to the small activating chip that will be removed when they wake up and left charging on the electrical network until the next night.
Juan Carlos Posé is in the last part of the process: configuring the intensity, frequency and start time of the electromagnetic impulses through sleep tests to adapt the operation of the device to his needs.
The first two patients underwent surgery in September. Now the third intervention is being prepared for a person who meets the inclusion criteria in the program: suffering from moderate or severe apnea and passing the drug-induced sleep videosomnoscopy test.
“Patients’ symptoms have improved significantly in terms of daytime sleepiness, sleep quality or snoring. We have confirmed the opening of the airway with each stimulation of the implant, and we are awaiting the latest tests to increase the intensity,” says Mackers. For specialists, the therapy is revolutionary, practically a cure for apnea.
According to the doctor, the idea of ??the ENT specialists is that it become financed by social security with the aim of giving an opportunity to ‘abandoned patients’. But it is the most expensive alternative. The value of the implant is around 25,000 euros, to which must be added the operating room or subsequent modulations.
It’s worth it, in the opinion of Juan Carlos Pose. The chip would not be microscopic – “what a bug I thought when I saw it” – but under the skin it does not cause any discomfort. “The comfort is incomparable compared to CPAP, that helps you rest.”
