As many as seven in 10 obstructive sleep apnoea patients who used a continuous positive airway pressure machine to keep their airway open during sleep eventually stopped using it due to discomfort and inconvenience, according to a study by Singapore General Hospital.
However, not using a continuous positive airway pressure machine (CPAP) and leaving their sleep apnoea untreated affects their quality of life due to excessive daytime sleepiness and puts them at a higher risk of health issues such as high blood pressure, heart disease and stroke, due to airway obstruction causing lack of oxygen and frequent awakenings.
These patients now have another treatment option known as hypoglossal nerve stimulation (HGNS).
It was introduced by the Department of Otorhinolaryngology – Head & Neck Surgery and Sleep Centre at Singapore General Hospital (SGH) in May 2022.
Dr Shaun Loh, Consultant, Otorhinolaryngology – Head & Neck Surgery, SGH, said: “HGNS therapy is a good complement and alternative to other treatment options because it is the only procedure that addresses the issue of weak muscles in patients’ airway, to allow them to breathe during sleep.
“This new form of therapy addresses the current gap that we have in the treatment for obstructive sleep apnoea, and will benefit patients who are not able to tolerate CPAP use.”
The treatment involves a two-hour procedure under general anaesthesia to implant a small device about the size of a cardiac pacemaker in the chest just below the collar bone.
This is done via two small incisions of about 5cm over the right chest and under the chin.
Patients are kept under observation for a day in the hospital after surgery.
As the surgery is generally well-tolerated with minimal risk of complications, recovery is quick and there is minimal pain. It is very likely to become a day-case procedure in the future.
Patients return to the hospital about a month post-surgery to activate their device and learn how to adjust the settings.
Thereafter, the patient just needs to turn on the device with a handheld remote before going to sleep and turn it off when awake.
During sleep, the device will monitor their breathing and sends a gentle pulse every time they take a breath to move the tongue out of the way, keeping the airway open.
Mr Foo, 55, had the HGNS surgery last year at SGH.
He was first diagnosed with severe sleep apnoea 10 years ago and was put on CPAP therapy but could not get used to it.
He underwent surgery to his nose and throat but these failed to fully resolve his sleep apnoea.
Due to persistently poor sleep quality and daytime sleepiness, he was evaluated and offered the HGNS device.
Since his surgery, he has been using his device for five months and is now able to
achieve good quality restful sleep throughout the night without being awakened and as a result, he is able to function better during the day.
In total, 20 patients had undergone the procedure at SGH by the end of April 2023.
More than 20,000 patients have benefitted from this device worldwide.
