STATEN ISLAND, N.Y. — James Collins, a 29-year-old hospital administrator from Travis, couldn’t understand what was causing his chronic fatigue.
“Even just sitting down on the couch was a no-go,” he said. “I would fall right asleep.”
Concerned his snoring might be a clue, his wife, Bianca, used her cellphone to record episodes of James “gasping for air” while napping on the couch. A sleep study revealed he was suffering from severe obstructive sleep apnea, or OSA — a serious condition where breathing repeatedly stops and starts during sleep due to a blockage in the upper airway.
Sleep apnea affects 30 million Americans, according to the American Medical Association. If left untreated, it can lead to a variety of health issues including heart disease, stroke, Type 2 diabetes and liver damage. It can also impact cognitive function and increase the risk of accidents due to daytime sleepiness.
A key indicator of severe OSA is an Apnea-Hypopnea Index (AHI) score of 30 or greater, meaning a person experiences 30 episodes of complete pauses in breathing (apneas) or partial reductions in breathing (hypopneas) per hour of sleep.
James scored 38.2 on the AHI test. With a new baby on the way, he knew he had to address the problem quickly.
His diagnosis qualified him for an implantable device called Inspire, and he was referred to Dr. Shanmugappiriya Sivarajah, a head and neck surgical oncologist and reconstructive surgeon at Richmond University Medical Center who has been performing Staten Island’s first Inspire procedures since August 2024.
Alternative to CPAP
Inspire therapy is a mask-free solution for OSA, and an alternative to the often cumbersome CPAP (continuous positive airway pressure) machine. It involves tunneling an electrode from the hypoglossal nerve in the neck, which controls tongue movement, to a small battery-powered device implanted under the skin in the chest area.
“The battery is tucked near the level of the pectoral muscle, so you can’t feel it or see it,” Dr. Sivarajah stresses.
When needed, the Inspire device sends mild stimulation to move the tongue forward and prevent the airway from collapsing during sleep, eliminating the obstruction. The patient remote allows the user to turn on the treatment before falling asleep and turn it off when awake.
A 90-minute surgical procedure involves two incisions and is performed on an out-patient basis with a two-week recovery period. A month after surgery, the device is turned on and its strength is adjusted for comfort. Two months after surgery, another sleep test is administered.
“It’s rewarding to see patients experience a significant improvement in their quality of life” with Inspire therapy, Dr. Sivarajah says. “They sleep better, and longer. There is less snoring and less disruption. They have more energy and no longer need a nap during the day.”
“A lot of people may have sleep apnea for years, but may not notice how it’s affected their quality of life – until it gets treated,” she added.
Dr. Sivarajah reassures patients that Inspire, which has been FDA-approved since 2014, is MRI compatible and does not trigger alarms at the airport. An app monitors use of the device and provides 24-hour support.
“It takes a bit of counseling and patient education” to operate Inspire and adjust the strength of the pulse, the surgeon adds. “People tolerate it very well without complications. CPAP is the gold standard for sleep apnea; patients who are non-compliant or claustrophobic become candidates for Inspire.”
Joined on cases by Dr. Christopher Lisi, chief of RUMC’s Division of ENT Head and Neck Surgery, Dr. Sivarajah sees patients of all ages, from 20 to 70.
With obesity rates trending upward in the U.S., sleep apnea is diagnosed more often, Dr. Lisi says, and many people are undiagnosed.
Now the parents of a new baby girl, Lena, the Collinses are relieved that James’s OSA is under control after surgery last December. On the second sleep test post-surgery, he experienced only one apneic event.
“I feel a lot better,” the new father says. “I used to wake up every 40 minutes. Now I can sleep through the night, and I’m able to do the parenting thing a lot better than if I was still struggling.”
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