Abstract
A strong demand for new obstructive sleep apnea (OSA) therapies exists and several
are emerging. Hypoglossal nerve stimulation is designed to activate upper airway muscles.
The initial study from Inspire (Maple Grove, MN) suggests that the device will work
well in a very selective group of OSA patients. However, it is likely to be quite
expensive. The Winx device (ApniCure, Redwood City, CA) works by establishing a vacuum
in the oral cavity, which pulls the uvula and soft palate forward and stabilizes the
tongue position. The current device works in approximately 40% of patients and the
early data suggest adherence may be quite good. The Provent device( Theravent, San
Jose, CA) has been available for several years and is disposable. It is to be attached
to the nares nightly and establishes substantial expiratory resistance. Multiple studies
suggest that Provent can successfully treat OSA in about 35 to 50% of the patients.
However, acceptance and adherence may be a problem. OSA phenotyping is not a therapy,
but a way to determine exactly what causes airway collapse in each patient, which
can vary substantially. This may allow for individualization of apnea therapy. New
methods to prevent supine sleep and surgically implantable devices to treat OSA are
also evolving.
Keywords
sleep apnea - hypoglossal nerve - Winx - Provent - phenotyping
