Joey Wahler (Host): It addresses an often debilitating condition. So we're discussing the Inspire procedure to treat sleep apnea. Our guests from Southeast Georgia Health System, Dr. Sherman Stevenson, he's a Board Certified Otolaryngologist, Ear, Nose and Throat Surgeon and also Chief of Surgery. Sarah Mobbs is with us, a Nurse Practitioner in Pulmonary Medicine. Plus we're joined by James Skiba, a patient of theirs.

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Host: This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler. Hi there. Welcome to all of you. Thanks for being with us.

Sarah R. Mobbs, FNP, FCCP: Hi, thank you.

Sherman A. Stevenson, MD: Hello.

James Skiba: Hello.

Host: Appreciate the time indeed. So first for you, Dr. Stevenson, what inspired, no pun intended, talking about the Inspire procedure, of course. What inspired your career in healthcare in a nutshell, and your interest in your particular field? Where did it all start for you?

Sherman A. Stevenson, MD: I grew up in a medical family. My father was a veterinarian, so I always thought that I would be in medicine. It just switched to human medicine down the road, and ear, nose and throat surgery always interested me due to the anatomy, the complex anatomy of the head and neck.

Host: Interesting and so what brought you to the area and to Southeast Georgia Health System ?

Sherman A. Stevenson, MD: The warm weather. We had moved down the coast and the hospital had an opening for ENT and they actually contacted me years ago and asked if I would be interested in moving to the area. And we came down and looked and just fell in love with the environment.

Joey Wahler (Host): So veterinary medicine and the warm climate for you. How about yourself, Sarah? Why healthcare and your chosen area of expertise would you say?

Host: At a very young age, my father was ill, and so I decided after being touched by those caregivers that I too wanted to be similar. And so I went into that and I'm actually from the area, so I moved away for 10 years and decided to come back and help my community and treat them like family and my neighbors.

Joey Wahler (Host): Seems a number of people go into healthcare because of a healthcare related experience that touched them and their family early on, right?

Sarah R. Mobbs, FNP, FCCP: I would agree. 

Joey Wahler (Host): So, James, how long have you lived in the area and what can you tell us about yourself?

James Skiba: I lived in the area since, 1991. Navy brought me down here. I am a Navy retiree, retired in 1999 and stayed in the area. I'm what they call a double dipper, I guess, because I went to work again after retiring from the Navy and put in 14 years with a company called Electric Boats, fixing submarines.

Host: So you stayed in that general field then, huh?

James Skiba: I did.

Host: Well, you're certainly entitled to double dip, right? Thank you for your service. Of course. We'll get back to you, James, in just a moment. Dr. Stevenson, remind us, please simply put, what is sleep apnea and what are its symptoms?

Sherman A. Stevenson, MD: Sleep apnea is when the airway collapses or obstructs when you're breathing during sleep. It can be measured with a sleep study and obstructive sleep apnea as opposed to central sleep apnea is a anatomic obstruction. There is a central apnea where your brain forgets to ask you to breathe that would not qualify for the Inspire or other treatments for sleep apnea.

Host: So what are the typical symptoms, and if I'm correct, if untreated, sleep apnea can lead to other conditions as well, right?

Sherman A. Stevenson, MD: It can. Snoring is a sign that the family often notices that can suggest sleep apnea, but daytime fatigue, headaches, cardiac arrhythmias, obesity, diabetes, those are all things that can go along with sleep apnea.

Host: Gotcha. And so what is this Inspire procedure? I love the title. I'm inspired just by the title Doc. So what is Inspire and how does it treat sleep apnea exactly.

Sherman A. Stevenson, MD: Up until the Inspire was developed, the mainstay treatment has been positive pressure that Sarah will talk to you maybe a little bit about, and it is the gold standard therapy. So the Inspire is for people who cannot tolerate the gold standard therapy of CPAP or BiPAP. It works to send a small stimulus to the airway to stay open when you inhale, similar to the CPAP or BiPAP pressure masks.

Host: And so you led me beautifully into my next question for you, Sarah. How does this procedure then differ from using that CPAP machine for sleep apnea? How does it differ? And also, of course, benefit the patient.

Sarah R. Mobbs, FNP, FCCP: Inspire is very different from a CPAP or BiPAP. It allows the patient to be more custom fit to what their body needs in response to the nerve that it's triggering, to help open their airway. So a lot of patients receive benefit from that thorough follow through and constant tweaking to what their body is telling us it needs.

Host: So any risks or side effects with this procedure?

Sarah R. Mobbs, FNP, FCCP: Of course there's always a risk with anything we do. However, this procedure does have very low risks. Infection is always a possibility. Luckily the infection rates are extremely low. And then the other I guess risk that could be associated is just, it does take several weeks to finish healing, although it's very minimal.

So it can take weeks to actually get the patient all the way to goal therapy about 12 weeks. However, they're recovered within days.

Host: Great to hear that. And so in layman's terms, what can a patient expect when undergoing this procedure?

Sarah R. Mobbs, FNP, FCCP: Typically when undergoing this procedure, the patient would get two incisions. It's a small cut right under the chin and a small cut on the chest. Our surgeon here at Southeast Georgia Health System has done over a hundred of these now, has been very efficient and effective at definitely doing minimal incisions and minimal recovery time.

Host: And then why would you say, James, and we'll get back to you, James, in just a sec; why would you say James was a good candidate, Sarah, for this procedure?

Sarah R. Mobbs, FNP, FCCP: I think a lot of our candidates are because we know that their sleep score qualifies them. So they've had already an early intervention with a sleep specialist. We also know that they have tried and failed a sleep machine. We would never want a patient to undergo a surgery, that hasn't tried things prior to that.

And then we also know that their ability to handle, even though it is a small surgery, to handle that type of procedure and the recovery and the hands-on technology is within the means to make them successful.

Host: And you mention a sleep score, what is that exactly?

Sarah R. Mobbs, FNP, FCCP: So every time a patient gets a sleep study, we are watching their abnormal breathing patterns and using that to help diagnose the severity of their sleep apnea. And as Dr. Stevenson touched on, we are specifically looking at obstructive sleep apnea with the Inspire.

Host: So James, that all being said, what made you first seek the treatment you received here from Southeast Georgia Health System? What was going on with you?

James Skiba: Well, I had the CPAP and I had the CPAP first in 2011, so for quite a while. My youngest son had been evaluated for the Inspire about five years previous to my introduction to it, and he was not a good candidate, unfortunately. But, it made me aware that there was something other than a CPAP available. 

So I finally got off, decided to pursue it, I think it was almost two years now. It'll be two years in September since I had the, uh, implant.

Host: So because it ran in the family, so to speak, you had some prior knowledge it sounds like, and so can you share your experience with this Inspire procedure working with Sarah and Dr. Stevenson?

James Skiba: The surgery itself was outpatient care. I did not have to stay in the hospital overnight. Recovery time was probably quicker than I expected it to be. I had no issues there. But it took me a while before they were able to activate the unit. You know, I guess it's for a complete, I don't know how to say it.

Host: Just to make sure that you were fully ready for that at that stage. Right?

James Skiba: That would be it. Yeah.

Host: And when we talk about the unit, as James put it, Dr. Stevenson, what is he referring to there?

Sherman A. Stevenson, MD: The unit that drives the treatment is a small unit, about half the size of your car key remote that gets implanted in your chest and it sends a signal to your tongue when you take a breath to have your tongue muscles activate and open your airway. You turn it on when you go to bed and you turn it off when you wake up and it stays in there out of sight until it needs a new battery in approximately 10 to 12 years.

Host: So it kicks in when you're ready for sleep, right?

Sherman A. Stevenson, MD: You turn it on and there is a delay of approximately 30 minutes so that you have time to go to sleep, and then it will start gently sending a signal to your tongue and airway to open when you take a breath.

Host: So Doctor, once this is up and running, in a case like James's, any lifestyle or dietary recommendations for patients going forward who have had this procedure, what needs to happen at that point?

Sherman A. Stevenson, MD: Well, long term after the first 30 days of healing, you usually have no restrictions at that point. While you're healing, we have you limit your strenuous activity and you are unable to have an MRI for those first 30 days. But to the diet, we just recommend a healthy diet for a good weight management, for sleep apnea.

Host: Gotcha. Sarah, how about any ongoing follow up care or monitoring that I'm sure is necessary for patients with the Inspire device? What do you and yours provide for someone like James there?

Sarah R. Mobbs, FNP, FCCP: Our typical follow up program for an Inspire patient is once they are cleared by the surgeon, approximately two weeks after the initial surgery, they would then follow up with us within those 30 to up to 60 days for an activation. They would ideally be already established with us, but that's not a necessity.

We could be seeing them for the very first time ever on our team, and we will be activating them, teaching them how to use the remote, starting them at very low settings so that, that way over the course of the next 12 weeks, they have an opportunity to continue to heal, start therapy early, and then titrate slowly so that they can adjust and benefit the most.

Host: A couple of other things here. James, you touched on it a bit earlier, but if you could expand some, please. What were your recovery time and postoperative care like? How would you describe it?

James Skiba: As the doctor said, a restriction on, or lifting anything heavy, those are kind of normal things, I guess on any surgery. I'm a good healer, I guess. I think I, you know, came through it pretty well and really didn't have any effects that I would mention. It's been pretty smooth going for me.

Host: Being a great healer. That's definitely a, an advantageous quality to have in life. How about James, your life before and after the procedure? What would you say are the main differences, lifestyle wise, and of course mainly and how you're feeling these days.

James Skiba: Well, one of the things is, I, am a snore person. I do believe that this has helped reduce my incident of snoring or made it, not as prevalent. So that's made it a lot better. My wife used to kick me when I start snoring and wake her up, unfortunately. And while I was on the CPAP, I'd break the seal with that CPAP unit and that would wake her up. And it was just, it was a struggle with the CPAP. So, it's been very smooth after getting the implant.

Host: So it sounds like Mrs. Skiba is a big fan of the procedure as well. Dr. Stevenson, what should general practitioners know about referring a patient for this Inspire procedure?

Sherman A. Stevenson, MD: There are a few criteria to make you eligible for the Inspire. Having tried the gold standard therapy of CPAP, weight loss, maybe even an oral appliance, if you have mild apnea and failing, you have to have enough apnea to qualify for it. So stop breathing a minimum of 15 times per hour, a maximum of a hundred times per hour.

You have to have a body habitus or a body weight that is not too large. And a BMI or a density under 40. You have to have tried CPAP and failed and had a recent sleep study less than two years ago. As long as those have been met, then we have to do an endoscopy where we watch you sleep to see if the Inspire would actually work.

So you have to go to sleep for an outpatient endoscopy that takes approximately five minutes. We watch you obstruct and make sure that the implant would correct this obstruction, and at that point then it's up to the insurance company to provide authorization to let us go to implant.

Host: So those are the parameters. Sarah, how about the role that patient education, so to speak, plays in the success of this? What do patients need to be aware of and make themselves available to?

Sarah R. Mobbs, FNP, FCCP: I think one of the largest, benefits to our patients with their education regarding the Inspire is that there is an app for smart devices both on Android and Apple products. It's called Inspire Sleep. It's a little blue cloud, and that product is what we would be using to help the patient track their sleep quality with the device. But it also has quick 30 to 90 second videos regarding additional patients, not just Mr. Skiba, but others all over the country that have benefited and what they are using for tips and tricks, how to use the remote that comes along with the device, recovery time. Patients hardly ever complain about pain.

So I think all those things are available to them in these short videos, and a lot of patients seem to respond to that education really well. The remote that helps control the generator, which is the implant, is four buttons, and a lot of people like to see that before the surgery, so that helps them feel confident and successful afterwards.

Host: All right. Sounds very comprehensive indeed. In summary here, James, any advice you might have for others joining us that may be struggling as you once were with sleep apnea who are on the fence about this procedure? What would you say to help them make a decision?

James Skiba: If they're dahing difficulties with one of the other choices like the CPAP as I did, the sooner to get into it the better, as far as I'm concerned. I wish I'd done it five years sooner.

Host: I think that says it all right there. Folks, we trust you are now more familiar with the Inspire procedure for sleep apnea. Dr. Stevenson, Sarah, keep up the great work and James continued good health and thanks again to all of you for sharing this inspiring story.

James Skiba: Thank you.

Sherman A. Stevenson, MD: Thank you.

Host: And for more information, please visit sghs.org/ent.

If you found this podcast helpful, please do share it on your social media. And thanks again for being part of Health Matters from Southeast Georgia Health System.