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An implant for obstructive sleep apnea — a serious sleep malady in which breathing stops for 10 seconds to two minutes many times an hour each night — works best in people who are overweight but not severely obese, a new study found.
To qualify for the device, called a hypoglossal nerve stimulator, a person over 18 diagnosed with moderate-to-severe obstructive sleep apnea must be unable to adapt or refuse to wear a continuous positive airway pressure, or CPAP, machine, the gold standard treatment for obstructive sleep apnea.
President Joe Biden speaks with members of the media before boarding Marine One on the South Lawn of the White House in Washington, Wednesday, June 28, 2023, for a short trip to Andrews Air Force Base, Md., and then on to Chicago. Biden has started using a continuous positive airway pressure, or CPAP, machine at night to help with sleep apnea, the White House said Wednesday after indents from the mask were visible on his face. (AP Photo/Andrew Harnik) Andrew Harnik/AP
The new study, published Thursday in the journal JAMA Otolaryngology — Head & Neck Surgery, looked at the body mass index of 76 patients who had received the implant, said senior author Dr. Eric Landsness, an assistant professor of neurology and sleep medicine at Washington University School of Medicine in St. Louis.
Currently, the implant surgery, which costs between $50,000 and $100,000, is approved and covered by Medicare and many insurance companies for people with a BMI of up to 40.
However, “we found for people with a BMI of more than 32, the device might be unsuccessful up to 75% of the time,” Landsness said. “It was a linear relationship: For each unit increase in BMI beyond 32, the odds of successful treatment decreased by approximately 17%.”
As currently defined, a BMI between 18.5 and 24.9 is a healthy weight, between 25 and 29.5 is overweight, between 30 and 34.9 is obese, between 35 and 39.5 is class 2 obesity, and anything over 40 is “severe” or class 3 obesity, which used to be called morbid obesity. People are considered underweight if their BMI is lower than 18.5.
The study also found the implant was less successful for people who slept on their backs, or what is called the supine position.
Freshly woken up young woman enjoying the morning sun rays. SimpleImages/Moment RF/Getty Images/File
The study’s results are consistent with earlier research that showed the efficacy of the device; however, “it also raises questions about whether obesity or supine sleeping limit its effectiveness,” said sleep specialist Kristen Knutson, an associate professor of neurology and preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. She was not involved with the study.
“There’s a huge unmet need of patients that are suffering with obstructive sleep apnea and not able to tolerate CPAP,” Landsness said. “But this is a surgery, which always carries risk, and it’s expensive, so as doctors we need to be sure the stimulator is the right choice for that patient.”
Adjusting to CPAP
To use a CPAP, a sleeper places a mask over the nose and mouth, then seals the mask to the face with straps and turns on a machine connected to the mask by a hose. Based on that person’s unique requirements, the machine provides air at a pressure just high enough to prevent the collapse of the airway during sleep.
Many people, however, find the mask claustrophobic and ill-fitting, the tubing constrictive and cumbersome and the air pressure either inadequate or too forceful. Many people wake up frequently during the adjustment period, leading some to say their sleep is worse than before starting treatment.