Sleep Apnea Treatment for Polio Survivors – Is INSPIRE It?
From Dr. Bruno:
More than three dozen studies of polio survivors have found higher rates of sleep disorders – than in the general population.
sleep apnea in 7% to 65%,
hypoventilation (shallow breathing and apneas causing carbon dioxide retention and low oxygen levels) in 15% to 20%
and restless legs in 28% to 63%
As many of you know too well, the treatment usually prescribed for apnea and hypoventilation is CPAP, a machine that continuously blows air into your mouth and/or nose to keep your airway open. Although we recommend BiPAP - which blows air at a higher pressure when you breathe in and at a lower pressure to let you exhale carbon dioxide - several Post-Polio Coffee House members recently have asked whether the Inspire electronic nerve stimulator being advertised to treat obstructive sleep apnea would be appropriate for polio survivors.
I didn't know. So I did some research and called the company.
The Inspire Sleep Apnea system has three parts:
a monitoring device implanted like a pacemaker in your chest,
a stimulator wire surgically implanted under your chin
and a handheld remote control.
The monitor and stimulator work together to monitor your breathing and deliver electrical pulses to the nerve that controls your tongue’s movement. These pulses force your tongue to the front of your mouth, moving the "floppy" tissue obstructing your airway and clearing space for more air to pass. Source
Is Inspire for You?
Here are the inclusions and exclusions for use of Inspire:
OSA diagnosis: You must have an obstructive sleep apnea diagnosis with 75% obstructive apneas, central + mixed apneas <25% of the total percentage of apneas, and between 15 and 65 apneas per hour.
Failed CPAP therapy: This treatment is only intended for those who have already tried CPAP therapy and found it unsuccessful or intolerable.
BMI under 32: Inspire has not been tested on people with a body mass index (BMI) over 32.
Other restrictions and side effects: Inspire is not appropriate for those with complete concentric collapse of the soft palate, that is total blockage by the soft tissue (soft palate) behind the solid roof of the mouth due to collapse of both the soft palate itself and the soft tissue on both sides of the throat (see graphic).
Exclusion: any condition or procedure that has compromised neurological control of the upper airway.
Whoa! “Any condition that has compromised neurological control of the upper airway.” Isn't that what bulbar polio did, "compromised neurological control of the upper airway" by attacking the cranial nerves that come from the brainstem, especially those controlling the soft palate and throat, including our old friend the vagus nerve? (Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (Eighth Edition), 2015)
I called an Inspire company representative to ask if having had polio was an exclusion for using Inspire. After a little stumbling she said, “We didn't study polio survivors. The doctor would have to make her own decision.“
So is Inspire for you or for any polio survivor? Unlike the manufacturer of the vagus nerve stimulator, which has excluded polio survivors, the Inspire manufacturer is not taking a stance. So you have to do your homework. First, keep in mind that many polio survivors dislike electrical stimulation of any kind. And if you talk to an Inspire–trained physician, ask about potential adverse effects of Inspire stimulation on polio-damaged nerves that may have caused "compromised neurological control” of the muscles in your throat.
Talk to your doctor before making any decision.
Sources:
https://www.inspiresleep.com/ and
https://www.sleepfoundation.org/sleep-apnea/what-is-inspire-sleep-apnea-treatment