MetroHealth Connection
A dream treatment for sleep apnea
 Sleep apnea kills through cardiovascular complications and vehicular accidents.
“This is a huge public health problem," said MetroHealth sleep medicine specialist Joseph A. Golish, MD. “Between 30 and 40 million people in the United States have obstructive sleep apnea, and 90% of those cases are undiagnosed."
And the prevalence of obstructive sleep apnea (OSA) is getting worse, for reasons Dr. Golish said include:
- Obesity
- Aging population
- Pain clinics and opiate use
- Chronic heart failure
- Strokes
- Neuromuscular disease
Once diagnosed with OSA, the most common option is prescribing patients to use a CPAP (continuous positive airway pressure) device at night. But despite the proven health benefits of using CPAP devices, “Even in the best of hands, at least one-half of patients won’t continue using them," said Dr. Golish.
Some surgeries have proven effective in a portion of OSA patients — bariatric surgery; maxillo-mandibular osteotomy, or jaw realignment surgery; and removing obstructions such as giant tonsils — making the CPAP unnecessary.
But there are other options for some patients, including tongue-retaining devices, dental appliances and Provent, which has received a lot of recent media attention. Dr. Golish said patients are compliant with these options nearly 90% of the time.
“With Provent, the patient becomes their own CPAP engine,’’ explained Dr. Golish, who recently has been featured in The New York Times and on “Good Morning America’’ in reports about the device.
Provent is a patch that fits over the nostrils and has two small plugs, one for each nostril. With inhalation, the Provent valve opens and the airflow is nearly unobstructed, allowing for normal breathing. With exhalation, the valve closes and air is directed through small air channels, increasing resistance. That resistance creates a backpressure in the airways, dilating muscles that would otherwise collapse during the night.
“Provent is the biggest advance in sleep apnea therapy in three decades — a real game changer,’’ said Dr. Golish. Patients need to undergo a sleep study in order to get Provent covered by insurance, and a growing number of insurers cover the device.
In a study published last year in the medical journal SLEEP, researchers found that those who used Provent for a three-month period saw their apnea episodes fall sharply.
But Provent won’t work for everyone.
“Prime candidates for Provent have mild to moderate sleep apnea, and it might be good for some select patients with severe sleep apnea," said Dennis H. Auckley, MD, Director of the MetroHealth Center for Sleep Medicine.
But patients with chronic rhinitis, allergies and who breathe through the mouth may not be candidates if the Provent back-pressure doesn’t open their collapsed airway.
The Center for Sleep Medicine team see patients for evaluations and ongoing care of sleep disorders at the following MetroHealth facilities:
To schedule an appointment at any of our locations, call 216-778-3441.
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