Pacemakers and Sleep Apnea: Can They Help?

Sleep apnea is a type of sleep disorder characterized by snoring and daytime fatigue due to a cycle of intermittent breathing during sleep. There are two main types of sleep apnea: one is called obstructive sleep apnea (OSA), the other type is central sleep apnea (CSA) which tends to be less common.

In OSA, the throat muscles relax during sleep and the airways can block as a result. This condition tends to affect more men than women – especially if they are obese. In OSA, the snoring is loud and excessive and may be accompanied by gasping or choking noises – as the body's reflexes cause the sleeper to have a subconscious arousal and resume breathing.

This cycle of intermittent breathing can occur many times during the night disrupting sleep and the body's oxygen levels.

CSA may accompany conditions like stroke and heart failure. It can also occur at high altitude. Although the snoring may not be as loud, there may be long pauses without breathing due to a problem between the signal in the brain and muscles that tell the body to breathe.

Both conditions affect the quality of life, mental and overall physical health. Extreme daytime fatigue as a result of poor sleep leads to problems concentrating, irritability, memory loss and accidents. 

The conditions have been linked to cardiac problems, diabetes and high blood pressure – so it's really important to get a diagnosis and appropriate treatment for OSA and CSA.

Treatments for sleep apnea

Once a diagnosis has been made, some lifestyle changes can help relieve the symptoms. Some of these include changing your sleeping position (usually avoiding sleeping on your back), limiting alcohol and losing weight. 

Positive airway pressure (PAP) therapy is one of the most effective treatments available. A PAP device delivers air through a tube connected to a mask worn by the sleeper. This airflow helps to keep the airways open so the sleeper can obtain a sufficient amount of oxygen. 

PAP therapy can have very good results if people use it consistently. However, some people find the therapy difficult to maintain and dislike wearing a mask during sleep.

Pacemakers and sleep apnea

As medical technology continues to advance, there are trials underway using pacemakers to help stimulate nerves that assist with breathing. 

Most people have heard of pacemakers for heart conditions, but this is a pacemaker designed to stimulate the hypoglossal nerve. The hypoglossal nerve is the main nerve for the tongue. If this is stimulated, the tongue stiffens which helps to stop the airway closing which helps prevent the airways blocking as occurs in OSA. 

The pacemaker requires a short surgical procedure to fit it and a follow-up to ensure that settings are adjusted to suit the patient. 

It is composed of three elements: 

  • a stimulation electrode implanted on a hypoglossal nerve 
  • a sensing electrode in the chest which detects when someone is about to inhale 
  • an electrical generator that powers the pacemaker 

Trials so far look very promising; oxygen levels during the night show improvement and there is a reduction in breathing stoppages. Measurements concerning quality of life and daytime fatigue indicate people's general well-being seems more positive. 

Other good news suggests that there are few side effects. However, the cost of the hypoglossal pacemaker is still extremely high, and more trials are needed to demonstrate its effectiveness with obese patients. 

Pacemaker therapy may help CSA, too. Research is underway to look at a pacemaker that stimulates the phrenic nerve to help with contraction of the diaphragm. 

The idea of this is that the pacemaker will sense the absence of breathing and stimulate the phrenic nerve, contracting the diaphragm to start inhalation. Studies so far are promising, but the pacemaker has not been approved for use in America yet.

The future

As understanding of OSA and CSA improves – and advanced technologies to develop new treatments and therapies are being assessed – the outlook for managing this condition is positive. 

If you or your partner have been diagnosed with sleep apnea, it's important to work with your sleep specialist or health professional (i.e. Otolaryngologist, ENT) to determine the best therapy for your particular condition and circumstances. 

Your health professional and sleep specialist will be aware of new developments in research and the best currently available treatment for the condition. They can also discuss lifestyle changes that you can make to help alleviate your symptoms and discuss any products available that may help you.

To read more about the potential for pacemakers in the treatment of OSA and CSA: