Snoring impairs sleep – and mainly that of the partner. That’s true, but if snorers repeatedly stop breathing, it can be not only disturbing but even be dangerous. In the long run, this obstructive sleep apnea (OSA) can have harmful effects on various organs of the body. These respiratory pauses usually last between ten seconds and one minute. They don’t only affect the metabolism, but also damage the brain and lead to cardiovascular problems such as high blood pressure, cardiac insufficiency, cardiac arrhythmia, diabetes, renal insufficiency and even heart attacks. Statistics show that snorers who suffer from breathing difficulties are three to four times more likely to die prematurely.

In a study of 5,712 patients with sleep apnea, researchers led by Matthew Butler of the Oregon Health and Science University have found that short breathing interruptions are even more dangerous than longer ones. The group with the shortest breathing interruptions had a 31 to 59 percent higher probability of dying in the following eleven years than those with lengthier interruptions. The researchers considered the reason for these results for people waking up repeatedly because they stop breathing, and the associated constant sleep interruptions that damage their health in the long term. In addition, these breathing pauses would put the body in fight or flight mode, which in turn elevates both heart rate and blood pressure. Men are most affected, but also elderly people, overweight people, and people who smoke, drink alcohol or use sedatives.

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Tongue pacemakers instead of breathing masks or lower jaw splints

In order to prevent these breathing interruptions, i.e. stop the muscles of the upper respiratory tract from slackening and thereby triggering respiratory arrest, respiratory masks or lower-jaw splints have been used up until now. However, these measures do not help all patients and some are unable to tolerate them. Scientists at the Friedrich-Alexander-University Erlangen-Nuremberg have now developed a tongue pacemaker – a small device that stimulates the tongue muscle and enables the air to flow again. The breathing pauses are either reduced or prevented altogether.

Surgeons at the ENT-clinic – Head and Neck Surgery from the University Hospital Erlangen implant these tongue pacemakers, and patients receive complete care from a single source: from diagnosis to surgery and aftercare.
“OSA is the most common night-time respiratory disorder,” explains managing senior physician PD Dr. Maximilian Traxdorf from the Erlangen ENT Clinic. “Sometimes, it can help to change your sleeping position, reduce your weight, and not drink alcohol before going to sleep. In mild to moderate cases, for example, lower- jaw splints can be used – they move the lower jaw forward and keep the airway open this way. But the gold standard in OSA therapy are the special breathing masks.” These CPAP masks (continuous positive airway pressure) generate a continuous slight overpressure and that’s how they keep the airways clear. “However, they are not tolerated by every patient, are not suitable for every body-type, and also do not always result in the desired success,” Dr. Traxdorf concludes.

© Inspire Medical Systems, Inc.

Tongue pacemaker keeps the airway clear

In the case of a moderate to severe OSA with 15 to 65 breathing pauses per hour, respiratory stimulation using a tongue pacemaker would be possible: “Only three small incisions on the neck and chest are necessary to be able to implant an impulse generator (pacemaker) in a small skin pocket below the collarbone.” The principle is comparable to that of a heart pacemaker. A breathing sensor in the tongue pacemaker measures the breathing rhythm and transmits a corresponding signal to the impulse generator. This generator activates the stimulation electrode on the tongue nerve, which in turn stimulates the tongue muscle whereby the tongue and the surrounding muscle tissue are prevented from falling back into the upper respiratory tract and blocking it. The airway remains clear and the air can flow in and out without interruption.

The tongue pacemaker is, of course, only used at night, after the patient has switched it on with a small remote control before going to bed. After getting up, they switch it off again. The battery has a lifespan of eight up to eleven years, then, it has to be replaced during a minor operation. “The tongue pacemaker reduces breathing interruptions or even prevents them. This leads to less snoring, fewer periods of waking up at night, and less tiredness the next day. Other side effects of OSA are also minimized – such as high blood pressure, headaches or depressive moodiness,” explains Maximilian Traxdorf. “In our sleep laboratory, we advise patients on potential therapies and on whether a tongue pacemaker might be suitable from a sleep medicine standpoint.”