UB head and neck surgeon provides new relief to sleep apnea sufferers

BUFFALO, N.Y. ­­— Individuals diagnosed with obstructive sleep apnea, which causes the upper airway to become blocked during sleep, often rely on a continuous positive airway pressure (CPAP) machine for relief

A CPAP machine delivers pressurized air through a face mask and prevents severe health issues associated with untreated sleep apnea, including heart disease, respiratory illness and stroke. While these machines work effectively for many people, other people find them cumbersome and uncomfortable.

Fortunately, there is an alternative ­— a device that is surgically inserted to deliver gentle stimulation to nerves controlling muscles that open up the airway.

In October, Michael Markiewicz, DDS, MD, MPH, professor and Feagans Endowed Chair of the Department of Oral and Maxillofacial Surgery at the University at Buffalo School of Dental Medicine, successfully performed the first implant nerve stimulator surgery on two adult patients at Kaleida Health’s John R. Oishei Children’s Hospital.

Each surgery lasted less than two hours and went smoothly, said Markiewicz, who has performed the procedure a number of times.

“Both patients went home shortly after the procedure,” said Markiewicz, who also serves as the clinical co-director of the Laurence C. Wright Craniofacial Center at Oishei and as an attending head and neck surgeon at Roswell Park Comprehensive Cancer Center. “We saw them a week later for a wound check, and they had no issues.”

The FDA-approved implant device, created by Inspire Medical Systems, stimulates the hypoglossal nerve — which controls functions of the tongue — and helps keep the airway open during sleep. The surgery includes two small separate incisions into the neck and chest and insertion of a stimulator coil and a respiratory monitor, respectively.

“They work together to measure breathing and stimulate the hypoglossal nerve,” Markiewicz  explained.

After patients undergo the surgery, they work with their physicians to fine tune their therapy settings and learn how to use a remote to turn the therapy on and off. The rate of complications for the surgery is low.

“Infection is extremely rare,” he said. “Overall, there is a minimal risk with this surgery.”

Sleep apnea surgery in children

“Our initial motivation for introducing this surgery at Kaleida was to eventually provide treatment for children,” Markiewicz said. “Additionally, we have seen a significant number of adult patients suffering from obstructive sleep apnea.”

Sleep apnea affects more than 30 million adults in the United States, although formal diagnoses represent only a fraction of this number, according to the American Academy of Sleep Medicine. The loss of adequate, uninterrupted sleep night after night can have a serious effect on sufferers’ personal and professional lives.

“Patients who have sleep apnea are often very fatigued. Daytime sleepiness is a common complaint,” Markiewicz said. “We also know that chronic obstructive sleep apnea has a profound impact on long-term health.”

While far fewer children experience it, certain conditions can result in sleep apnea in infants, children and teenagers. Risk factors include enlarged tonsils and adenoids, congenital craniofacial abnormalities in the skull or face, obesity, and Down syndrome.

“Typically, kids with Down syndrome have very large tongues and their airways are compromised,” Markiewicz explained. “They can have really bad obstructive sleep apnea. Because half of my practice focuses on pediatrics, I’m really excited about the opportunity to perform this procedure on children, especially children with Down syndrome when indicated.”

Not widespread use yet

Although the implant device has been on the market for almost a decade, it has not been widely used in Buffalo, and only a couple of surgeons, including Markiewicz, perform the procedure.

The patients who qualify for the surgery have undergone a sleep study and have met certain requirements, including an acceptable body mass index and the correct obstructive closure pattern in their airway. They may also have experienced problems with traditional CPAP therapy.

“It is meant for people who are CPAP resistant or who fail with the CPAP,” Markiewicz explained. “The typical story is ‘I hate my CPAP. I can’t wear it.’”

Markiewicz is now working with the pediatric sleep medicine team at UBMD Physicians Group and accepting referrals for the appropriate pediatric candidates for the implant surgery.

“We are all excited about the possibilities,” he said. “Eventually, I’m hoping we can open up this surgery to children who have sleep apnea for other reasons, too. However, approval for this may not be for some time.”