Dear Dr. Roach: Can you share as much information as you know about a procedure called Inspire that supposedly helps reduce the serious issues of sleep apnea?
What are the benefits, and how does it work? What are the risks, since the procedure does involve surgically installing a tiny motor and wiring in the chest with the wiring connected to the throat and the device operated by a remote?
Inspire has been recommended for me at age 77 because I have tried CPAP machines twice without success. A home test and sleep lab test revealed that my brain awoke 56 times in an hour. That’s serious sleep apnea and as you know, sleep apnea can be fatal or cause brain damage. My fear of Inspire is has to do with the motor and wiring in my body.
Obstructive sleep apnea is a common, underdiagnosed sleep issue. In a person with OSA, the soft tissues in the neck and throat close the airway when the muscles are relaxed during sleep. This prevents breathing until a person wakes up for a second or two, the muscles regain tension and the person can take a breath to get oxygen and exhale carbon dioxide. This can happen many times per night but not be remembered by the person.
Without treatment, there can indeed be long-term damage to the heart and lungs. Standard treatment is continuous positive airway pressure, using a tight-fitting mask to use air to keep the airway open. Being overweight or obese is a major risk factor, but some people have anatomy that predisposes to OSA even with normal weight.
The Inspire is not a motor. It is much more similar to a cardiac pacemaker, which is a very safe medical device using mature technology. It senses the breathing with a sensing lead near the muscles of the ribs, and causes a movement of the tongue by stimulating the hypoglossal nerve, allowing the breathing to be unobstructed. A seminal paper in 2014 showed that the device reduced the number of apnea events from 29 an hour to 9. Longer-term follow-up studies since then have confirmed its continued effectiveness.
Since the standard therapy of CPAP is not tolerated by many people, it is important to recognize that there are alternatives available. In my opinion, there is now enough evidence that this treatment is effective, and can be offered as an option for carefully selected patients.
Dear Dr. Roach: I am an 82-year-old overweight male. As a prophylaxis for COVID-19, I am taking 500 mg of quercetin, 30 mg of zinc, 1,000 mg of vitamin C and 25 mcg of vitamin D3 daily. What are your thoughts on this regimen?
The evidence that this regimen is effective at preventing COVID-19 infections is minimal at the time of this writing, although there are theoretical reasons why one or more may be helpful, and there are observational data showing that low vitamin D seems to be a risk factor for more severe disease. None of these supplements is likely to be harmful at the doses you are taking, but I think they are largely a waste of money. I would also caution you to be very careful thinking that by taking these supplements you will be protected. You almost certainly aren’t highly protected, and being overweight is a risk factor for more severe disease. You should be particularly careful about physical distancing and mask wearing.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu