On a recent episode of my podcast, I had the opportunity to once again sit down with Dr Ruchir Patel. He’s a sleep medicine specialist and perhaps one of the most notably experienced sleep medicine providers working with Inspire therapy. He’s considered to be a national expert on hypoglossal nerve stimulation, and together we give you an insider’s guide on two breakthrough therapies. The first is Inspire, which has been out since 2014, and we also discuss the newly FDA-approved hypoglossal nerve stimulator called Genio.
This is an episode you won’t want to miss, and here is why. As primary care providers, you see the consequences of untreated sleep apnea daily: cardiovascular risks, daytime fatigue, and missed opportunities for better health. Until recently, our options were limited.
Inspire therapy has been an added therapeutic modality for treatment of obstructive sleep apnea for nearly a decade now. It happens to be a small device, now implanted with two incisions since the latest version, Inspire V, came out on the market.
Inspire essentially works as a unilateral pacemaker for the tongue. The implant is initially placed in a pocket much similar to where you’d place a pacemaker or defibrillator, and there’s a second incision along the neck where there is a cuff that is wrapped around the distal part of the hypoglossal nerve. This allows for stimulation to the nerve that is timed with our breathing to move the tongue out of the way when we sleep at night.
Many of your sleep colleagues have already referred patients for consideration of hypoglossal nerve stimulation when patients are unable to tolerate CPAP or unable to do well with an oral appliance made by a dentist. The data for hypoglossal nerve stimulation suggests that up to 80% of patients are happy with their therapy, and the goal really is not complete resolution of obstructive sleep apnea. It is really to improve sleep apnea to the point where it’s at least mild compared to either moderate or severe obstruction.
2025 marks the first year that we actually have a choice. Genio was cleared by FDA this August and implantation has started. This offers a totally new approach. There is an incision that’s made in the submental region and a device is then placed, and there are two pads that go along the area where the hypoglossal nerve tracks. These pads essentially act as a stimulator that bilaterally gets the tongue to move out of the way. Both Genio and Inspire are now MRI-compatible, so your patients can get necessary MRI imaging when needed.
You may be wondering, “Which therapies are best for which patients?” That is still a question that sleep doctors are trying to answer, given the fact that Genio is still a very new technology and widespread implementation has not yet occurred in the United States.
Both devices do still require a drug-induced sleep endoscopy at this point, which is a procedure that occurs with the guidance of anesthesia where the patient is placed under sedation and the upper airway is monitored. Neither device works for complete concentric collapse of the upper airway. Both devices have criteria which include the patient having moderate-to-severe obstructive sleep apnea, with Inspire having a broader range of AHI severity compared to Genio at this time. Body mass index is also a broader range for Inspire than it is for Genio. Both products require that there are limited central sleep apnea events. What’s nice is we now will have, in the future, two therapies that can be tailored specifically to each patient’s anatomy, their preference, their lifestyle, and their risk profile.
In my episode with Dr Patel, he walks us through these advances, practical tips, and even debate about where the future of hypoglossal nerve stimulation will go. We raised the question, can these devices be paired with new medications to create even more individualized strategies for our patients?
Precision sleep medicine is here, it has arrived, and you don’t have to settle for a one-size-fits-all approach anymore. So, if you want to understand hypoglossal nerve stimulation, inspire hope for your sleep apnea patients, and find out what’s truly new in sleep medicine, I invite you to have a listen. Thank you.
