It is an exciting time to be an otolaryngologist in the world of obstructive sleep apnea. Clinical care pathways are rapidly changing, multidisciplinary collaboration is on the rise, and new treatment options are in development. Consistently ranked as one of the best otolaryngology programs in the country, faculty in the Department of Otolaryngology at the University of Pittsburgh continues to be at the forefront of these exciting new advances.
What is Obstructive Sleep Apnea?
In its simplest form, obstructive sleep apnea, or OSA, is the collapse and blockage of the upper airway or breathing passage during sleep. OSA has many causes and is often associated with loud, disruptive snoring, unrefreshing sleep, and daytime sleepiness, as well as harmful drops in oxygen levels, health problems, and car accidents. For decades, treatment options were somewhat limited – with most sleep centers offering either a CPAP mask and machine or a surgery that excises part of the throat – leaving many patients inadequately treated.
A New Approach to Better Sleep
Led by Ryan J. Soose MD, the region’s only otolaryngologist both fellowship-trained and board-certified in sleep medicine, the Sleep Division in the Department of Otolaryngology has pioneered a comprehensive, personalized, multidisciplinary approach to OSA. “In this model, we factor in each patient’s unique history and symptoms, anatomy and physiology, and goals and preferences for treatment, to tailor a personalized multimodality management plan,” explains Dr. Soose, an Associate Professor of Otolaryngology and the Director of the Sleep Division. “OSA treatment options at UPMC span the entire spectrum of medical and surgical treatments, including the management of other co-existing sleep disorders such as insomnia and restless legs syndrome.”
The new paradigm in the Sleep Division puts the sleep-trained otolaryngologist at the center of patient care rather than a surgical technician – comprehensively managing dozens of sleep disorders, ordering and interpreting sleep studies, prescribing and troubleshooting CPAP, collaborating with medical and dental colleagues, treating sinonasal and allergy conditions, and of course, thoughtfully employing surgical procedures.
Innovative Tech for Easier Breathing
One such novel surgical procedure, and arguably the biggest breakthrough in OSA treatment in decades, is the Inspire upper airway stimulation (UAS) implant. The UPMC Sleep Division has been instrumental in the research and development of UAS therapy – serving as the lead academic site in the multicenter pivotal STAR trial, authoring the landmark New England Journal of Medicine manuscript, and performing the first commercial UAS implant in the United States. “UAS therapy uniquely straddles the medical and surgical arms of treatment and offers unique advantages compared to traditional therapies,” says Dr. Soose.
UAS consists of a fully implanted neurostimulation device that is inserted during outpatient surgery. The device is turned on with a handheld remote at bedtime and works to keep the breathing passage open during sleep by increasing the muscle activity of the throat. UAS is an adjustable medical device controlled by the patient. Still, unlike CPAP and traditional OSA devices, the device is inserted under the skin, which avoids the discomfort of an external apparatus on the face or in the mouth.
Dr. Soose adds that “since UAS does not alter the anatomy of the throat or jaw, recovery and downtime are generally shorter than traditional surgical procedures. Furthermore, the electrical programming is titrated to each individual to optimize results and monitor outcomes across a long-term care model.”
This type of exciting, innovative research is only made possible with support from generous donors to the Eye & Ear Foundation. If you would like to be a part of this groundbreaking work being done, please consider making a gift to help support our research.
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