On Thursday Dr. Alan R. Schwartz, a pulmonologist from Johns Hopkins School of Medicine, provided a review of the current literature on neuromodulation of the upper airway in OSA. Currently there are three companies in various phases of clinical trials using neurostimulation of the tongue to prevent sleep apnea from occurring. The results so far are mixed, with each company reporting different levels of success. The use of a “pacemaker” to treat sleep apnea likely will be a component of future OSA treatment. How many companies will be engaged remains to be seen.
Pediatric OSA was a significant topic area during the conference. One of most promising treatments for OSA in children is rapid maxillary expansion. Dr. Paola Pirelli, an orthodontist who pioneered the use of RME, reported on the use of this technique.
The most interesting poster of the day, for me, added to the debate on calculating severity of sleep apnea. Prof. Andreo Larsen from Finland presented “Apnoea Load – A new supplementary index for assessing sleep.” He argued that the current measure of severity, the apnea-hypopnea index or AHI, does not take into consideration time or duration. He believes that a patient with longer apnea events (spending more time in a hypoxic state) has more severe disease than someone with the same number but of shorter duration. He calculates the apnoea load or AL by taking the average number of apneas per hour times the average duration of apneas in minutes. The AL would be a useful supplement to the AHI to identify borderline cases.I am confident that the field of sleep apnea research is good hands. My only worry, and it is not small, is who is dictating the direction of the work.