New implant offers hope for sleep apnea; experts for careful patient selection

Pune: A new implantable device designed to treat severe sleep apnea without major airway surgery is expected to be available in India soon, but specialists feel it will be suitable only for a small and carefully selected group of patients.The technology — hypoglossal nerve stimulator (HNS) — works somewhat like a cardiac pacemaker. Implanted under the skin in the chest, it monitors breathing during sleep and stimulates the nerve controlling the tongue whenever breathing pauses occur. The stimulation pushes the tongue forward, preventing the airway collapse that typically triggers obstructive sleep apnea.The implant can potentially avoid major cutting surgeries such as palatoplasty or excision of the tongue base."It is a proven technology and has been in use for more than two years in the US and other countries. It is likely to be approved for use in India this year," said senior ENT surgeon Dr Seemab Shaikh, founder national president of Indian Association of Surgeons for Sleep Apnea (IASSA).Elaborating, Dr Shaikh said, "Sleep apnea patients who cannot tolerate CPAP machines or who have specific anatomical causes of airway collapse often have to undergo invasive surgical procedures such as palate reconstruction or surgery on the base of the tongue. The implant could help some patients avoid such invasive procedures."Dr Shaikh emphasised that the implant treatment would not be offered indiscriminately."Sleep apnea is common, but this technology is meant for a very specific patient profile. Only a small subset of sleep apnea patients will qualify. The pattern of airway collapse has to be evaluated carefully before considering this implant. Proper selection will determine if the patient truly benefits," he said.According to data from a population study conducted by the All India Institute of Medical Sciences (AIIMS), Bhopal, sleep apnea may affect around 34% of the Indian population, suggesting that one in three adults may have some degree of the disorder. "However, only about 5% of these patients are likely to meet the strict clinical criteria required for the implant," Dr Shaikh said.The implant-technology has got the USFDA's approval. "More than 10,000 patients have been studied across the world, and the device is already in clinical use in the United States and several Gulf nations," said Kolkata-based ENT surgeon Dr Deepankar Dutta, vice-president, IASSA.The device is expected to cost around Rs35 lakh initially, making it inaccessible to many patients in the early phase. Experts say the trajectory could be similar to that of cochlear implants. These were priced at about Rs 12 lakh when introduced in India two decades ago, but now cost between Rs5 lakh and Rs7 lakh."Like many medical technologies, costs are likely to come down once adoption increases and local expertise grows," said Chandigarh-based Dr Sandeep Bansal, the president of IASSA.Sleep apnea, characterised by repeated pauses in breathing during sleep, is linked to hypertension, heart disease, diabetes, stroke and daytime fatigue. With rising obesity rates and sedentary lifestyles, specialists say the disorder is becoming increasingly common in India.While the new implant offers another option in the treatment spectrum, doctors stress that diagnosis, lifestyle changes, weight management and established therapies will continue to remain the cornerstone of care. March 13 is World Sleep Day.