LAUSR

Obstructive sleep apnea (OSA) is defined as the repetitive episodes of complete or partial occlusion of the airway occurring during sleep. OSA is thought to play a role in many different diseases including anxiety, depression, excessive day time sleepiness, and GERD. Treatment of OSA can often be difficult as many patients cannot tolerate CPAP. The patient is a 76-year-old male who was diagnosed with OSA in 1991. He had undergone Uvulopalatopharyngoplasty in 1997 and maxillomandibular advancement in 1999 but continued to have snoring and witnessed apneas and excessive daytime sleepiness (EDS). A repeat PSG in 2019 showed severe sleep apnea with an AHI of 37.3. The patient had been unable to tolerate his CPAP at home due to discomfort from the pressure. He was then referred for evaluation and subsequent placement of a hypoglossal nerve stimulator known as inspire by ENT. On follow-up at the sleep clinic, the patient complained that he was still having daytime sleepiness and snoring despite compliance with INSPIRE. A home study was done to evaluate the effectiveness of INSPIRE and his AHI was found to be 46. INSPIRE was reconfigured and a repeat sleep study was done which showed similar results. A decision was made to try combination therapy with INSPIRE and CPAP at a lower pressure than previously. His original CPAP settings were 12cmH20 and with combo therapy we were able to change this to autoPAP 7-10, which the patient tolerated well and showed good control of his sleep apnea with an AHI of 4.6. For those with moderate to severe OSA, the gold standard therapy is CPAP, but not every patient can tolerate CPAP therapy. One of the reasons is the CPAP pressure being too high. In 2014 the FDA approved a new treatment option for those with moderate to severe sleep apnea with the hypoglossal nerve stimulator. In our patient, multiple different INSPIRE configurations were attempted but he still had uncontrolled OSA and EDS. We were able to use combination therapy with INSPIRE and CPAP to adequately control his OSA without needing the high pressure that he could not tolerate previously.