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of reasons," says Kingman Strohl, MD, Director of Sleep Medicine at University Hospitals (UH) Case Medical Center and professor at Case Western Reserve University School of Medicine. While OSA is often associated with obesity, Dr. Strohl and his sleep medi- cine colleagues at UH emphasize that the problem arises from an underlying susceptibility of the upper airway to col- lapse during sleep — a condition that can affect anyone, of any size or age. "The problem can be anywhere from the back of the mouth or nose to the vocal cords," says Colleen Lance, MD, Director of the Sleep Center at UH Case Medical Center and assistant professor at CWRU School of Medicine. "It could be from an injury, deviated septum, a narrow palate, larger tonsils, or even a small jaw line crowding the tongue. If you add weight problems to any of these, you can increase the chances of having clinically significant OSA." Traditional Approaches to Treatment For children with OSA, the problem can usually be fixed by removing the tonsils and/or adenoids, but adult OSA is usually more complex. Some patients have found relief with dental appliances, worn at night, designed to shift the jaw forward and move the tongue out of the airway. Depending on the location and nature of the obstruction, surgery on the throat or soft palette is also sometimes an option, although these types of surgeries can be painful and invasive. But the most successful and popular approach to adult OSA has been Continuous Positive Airway Pressure (CPAP), a sort of "splint" that keeps the airway open with a continuous stream of air. Although a highly effective treatment for OSA, CPAP requires the patient to wear – each and every night – a cumbersome nasal mask attached to an electrical appliance. While 40 to 60 percent of OSA patients agree to try CPAP, many eventually quit using it. "CPAP is often a hard sell for patients because they are going to wear a mask and turn on a machine," says Dr. Lance. "Compliance can become a real problem with CPAP if they do not realize benefit. Some patients have claustrophobia (and, for that reason, won't wear the mask)." A New Alternative — Inspire Now there's a new treatment option for moderate to severe OSA – a n implantable electronic pacemaker-like system called Inspire Upper Airway Stimulation therapy. Approved by the FDA in May for the treatment of moder- ate to severe OSA in those who cannot or will not use CPAP, Inspire delivers Colleen Lance, MD, is Director of the Sleep Center at UH Case Medical Center where the Inspire system is exclusively offered in Northeast Ohio to select patients with OSA who cannot or will not use CPAP. PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON 2 0 1 4 N OV E M B E R / D E C E M B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 3