Amanda Wilde (Host): Obstructive sleep apnea, you've probably heard of OSA because millions of people have it. Whether you're experiencing sleep disturbances or keen to enhance your knowledge about this condition, you're in the right place. We'll hear today from Pulmonary and Sleep specialist, Dr. Umma Kulsum, and otolaryngologist Dr. Adrian Ong.

This is Jamaica Hospital Med Talk from Jamaica Hospital Medical Center. I'm Amanda Wilde. Doctors, thank you so much for joining me today. 

Dr. Umma Kulsum: Thank you for having us.

Host: Dr. Ong, start us off, and I'll refer to obstructive sleep apnea as OSA just to shorten it. Can you describe OSA, what it is and what causes it?

Dr. Adrian Ong: So, obstructive sleep apnea or OSA is a condition characterized by repeated interruptions in breathing during sleep due to blockage of the upper airway. The blockage can be in the nose, the back of the throat, or the tongue collapsing into the upper airway. These interruptions can last for several seconds to minutes, and often occur multiple times throughout the night leading to poor sleep quality and oxygen levels in the body.

Host: What causes this, Dr. Ong?

Dr. Adrian Ong: It can be due to a few different things. Most commonly, it is due to excessive amount of tissue in the back of the throat or the tongue falling back. During sleep, the muscles tend to relax and it tends to relax and fall back into the airway causing an obstruction.

Host: Dr. Kulsum, what are the symptoms of OSA and how many Americans have it?

Dr. Umma Kulsum: So, about the symptom, the most common symptoms of sleep apnea are snoring, loud snoring, excessive daytime sleepiness. Somebody might tell you that you stop breathing in your sleep. There are other symptoms also, like you feel very tired and sleepy during the day. You wake up multiple times from your sleep with gasping, choking sensation. You have a restless sleep. And you feel that the mouth is very dry when you wake up in the morning. And if you ask me how many Americans are suffering from sleep apnea, as per American Association of Sleep Medicine, almost 30 million Americans are suffering from sleep apnea, but a lot of them are actually undiagnosed.

Host: So Dr. Kulsum, if people are tired and sleepy, obviously living with OSA can affect someone's daily life. Does it affect your life in other ways as well?

Dr. Umma Kulsum: Sure. If you are feeling very sleepy and tired when you wake up in the morning, you have less cognitive function. You cannot focus on your work. You have less attention to your work, so it leads to decrease productivity. It also affect your memory. You lose memory very quickly. And another important effect is you can have a motor vehicle accident if you're driving sleepy, tired. When you are in the highway, you can have motor vehicle accident, which is risk to yourself and also to other people also.

Host: So, less function overall in all areas, just sort of points to the importance of uninterrupted sleep. So, Dr. Ong, in addition to what we've just discussed, this more limited function due to OSA, are there other serious health concerns for those who have OSA?

Dr. Adrian Ong: Yes. So for patients with obstructive sleep apnea, if left untreated, there are several serious health concerns that affect both short-term and long-term wellbeing for individuals. This can include an increased risk of heart attack and stroke, and like Dr. Kulsum mentioned, the cognitive concerns such as memory problems, decreased alertness and increased risk of motor vehicle accidents.

Host: Dr. Kulsum, I want to talk about how someone might get tested if there is such a thing. As their screening for OSA, but also how would someone know to ask for that?

Dr. Umma Kulsum: Okay. So if you ask about a screening, we have some questionnaire that we can ask the patient just to know what are the symptoms they have. But if we are talking about the diagnosis, we'll have sleep study that can help us to diagnose sleep apnea. There are two kinds of sleep study that we have right now. One you can do at home by yourself. It is called portable sleep study. Another type is you can do the sleep study in a sleep center that we call polysomnography.

Host: So, sleep studies are the standard for determining if someone has OSA, is that correct?

Dr. Umma Kulsum: Yes, that is the standard diagnostic tool for diagnosing sleep apnea.

Host: And then, Dr. Kulsum, once diagnosed, what are the treatment options for OSA?

Dr. Umma Kulsum: So, there are a variety of treatment that we can offer to a patient who is suffering. From sleep apnea. If they're suffering from mild sleep apnea, they can have a dental device. They can try to lose their weight. Sleep on their side. If somebody has moderate or severe sleep apnea, we offer CPAP or BiPAP treatment. And recently, you guys know we have Inspire for treatment of sleep apnea, which is for moderate to severe sleep apnea.

Host: Now, Dr. Ong, I understand there's a new form of treatment you're using at Jamaica Hospital Medical Center called Inspire. Can you talk about that, how it works?

Dr. Adrian Ong: So Inspire, like Dr. Kulsum alluded to, is the new treatment option for patients with moderate to severe sleep apnea. It's specifically for patients who cannot tolerate or do not benefit from CPAP therapy, and it is a surgically implanted device that helps to keep the airway open during sleep. It does this by stimulating nerves that control the muscles in the throat to help prevent collapse of the upper airway.

Host: And what kind of results have you seen from that, Dr. Ong?

Dr. Adrian Ong: Overall, the therapy is very well tolerated by patients. This is the therapy meant for patients with moderate to severe sleep apnea and over 80%, 85% of patients have a significant reduction in the number of apneic events or pauses in their breathing during sleep?

Host: Wow. So, it's fairly successful, wouldn't you say?

Dr. Adrian Ong: Yeah. I would say so, especially for patients who-- again, it's for patients who can't use their CPAP, which is our gold standard. So in my mind, these patients aren't getting treatment already, so at least they're getting some sort of therapy, and it's great that it's been so successful in a lot of these patients.

Host: So, there are benefits to Inspire over traditional treatment other than the CPAP machine.

Dr. Adrian Ong: Correct.

Host: And what are those benefits?

Dr. Adrian Ong: So, some other alternatives to treatment of sleep apnea can also include the more traditional sleep surgeries. This can include what we kind of call upper airway modification surgery. This can include nasal surgery such as a septoplasty or surgeries of the throat and tongue, and even the jaw.

So, compared to those traditional surgeries that impact only one part of the airway that collapses, Inspire actually helps to affect multiple areas of collapse in the airway. There's no removal of tissue or reshaping of the tissue. The recovery time for Inspire is typically shorter than the traditional sleep surgery that we used to do. And it's, like I said, effective for a wider range of patients who have multiple areas of collapse.

Host: So, it's really focused. Is anyone eligible to receive the Inspire therapy or does it just apply to the patients you mentioned that can't use the CPAP?

Dr. Adrian Ong: So, Inspire is specifically indicated for patients who are over the age of 18 years who have moderate to severe obstructive sleep apnea. They also must be either CPAP intolerant or do not benefit from CPAP therapy. They have to have a certain body mass index. Those are the main indications. There is a final test that's typically done called a drug-induced sleep endoscopy, which is done in the operating room to observe the patterns of collapse of their airway. As long as they don't have a certain pattern of collapse, then they are considered a candidate for Inspire.

Host: And with Inspire, are there any side effects or dangers, Dr. Ong?

Dr. Adrian Ong: Yeah. So with any surgery that we do, there are side effects or risks that most common general risk for surgery include pain, bleeding, infection, scar. The most common ones that I've seen from Inspire can be discomfort from the stimulation. However, after some time, most patients get used to the sensation and they sleep throughout the night without waking up. And of course, this is very helpful for patients who are, again, not getting treated by anything for their sleep apnea, but some patients may not achieve that desired level of efficacy for this treatment and may need some additional supplemental treatments, whether that's an oral appliance or an additional type of surgery to help just get them over the edge.

Host: Well, Jamaica Hospital Medical Center offers a wide range of services, obviously to people with OSA. Dr. Kulsum, how can people learn more about those services?

Dr. Umma Kulsum: Yes, you are right. We have different services for people with sleep apnea. We have sleep clinic. We have sleep center. If anybody is worried that they have symptoms of sleep apnea, they can come visit us in our sleep clinic. We have sleep clinics in different locations. And also, if we think that patient has symptoms of sleep apnea, we can do different diagnostic tests and offer the treatment which is suitable for them and they can learn more about it. Like they can go to MediSYS website, they can go to the sleep center, and they can find more information how they can have all these things done.

Host: Perfect. Dr. Kulsum, Dr. Ong, thank you so much for this information on obstructive sleep apnea.

Dr. Adrian Ong: Yes. Thank you again for having us, and great to know that people are learning more about sleep apnea and the treatment options that we offer here at Jamaica.

Dr. Umma Kulsum: Thank you.

Amanda Wilde (Host): That was Pulmonary and Sleep specialist Dr. Umma Kulsum and otolaryngologist, Dr. Adrian Ong. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts. And if you found this podcast episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Jamaica Hospital Med Talk from Jamaica Hospital Medical Center. Thanks for listening.

Disclaimer: All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.