Singapore, 13 March 2023 – As many as seven in 10 obstructive sleep apnoea (OSA) patients who used a continuous positive airway pressure (CPAP) machine to keep their airway open during sleep eventually stopped using it due to discomfort and inconvenience, according to a study by Singapore General Hospital (SGH). However, not using CPAP and leaving their sleep apnoea untreated affects their quality of life due to excessive daytime sleepiness and puts them at a higher risk of health issues such as high blood pressure, heart diseases and stroke, due to airway obstruction causing lack of oxygen and frequent awakenings.

These patients now have a new treatment option known as hypoglossal nerve stimulation (HGNS). It was introduced by the Department of Otorhinolaryngology – Head & Neck Surgery and Sleep Centre at Singapore General Hospital (SGH) in May 2022.

“HGNS therapy is a good complement and alternative to other treatment options because it is the only procedure that addresses the issue of weak muscles in patients’ airway, to allow them to breathe during sleep. This new form of therapy addresses the current gap that we have in the treatment for OSA, and will benefit patients who are not able to tolerate CPAP use”, said Dr Shaun Loh, Consultant, Otorhinolaryngology – Head & Neck Surgery, SGH.

The treatment involves a two-hour surgery under general anaesthesia to implant a small device about the size of a cardiac pacemaker in the chest just below the collar bone. This is done via two small incisions of about 5 cm over the right chest and under the chin. Patients are kept under observation for a day in the hospital after surgery. As the surgery is generally well-tolerated with minimal risk of complications, recovery is quick and there is minimal pain. It can possibly be performed as a day surgery in future.

Patients return to the hospital about a month post-surgery to activate their device and learn to adjust the settings. Thereafter, the patient just needs to turn on the device with a handheld remote before going to sleep and turn it off when awake. During sleep, the device will monitor his breathing and sends a gentle pulse every time he takes a breath to move the tongue out of the way, keeping the airway open.

55-year-old Mr Foo is one of our patients who had the HGNS surgery last year. He was first diagnosed with severe sleep apnoea 10 years ago and was put on CPAP therapy but could not get used to it. He underwent surgery to his nose and throat but these failed to fully resolve his sleep apnoea. Due to persistently poor sleep quality and day time sleepiness, he was evaluated and offered the HGNS device. Since his surgery, he has been using his device for 5 months and is now able to

achieve good quality restful sleep throughout the night without being awakened and as a result, he is able to function better during the day.

So far, 10 patients have undergone the procedure at SGH and have posted good results. Another 10 patients are scheduled to have their surgery by the end of April 2023. More than 20,000 patients have benefitted from this device worldwide.

It is estimated that 1 in 3 Singaporeans suffer from OSA. It is a common, serious and potentially life-threatening disorder that causes recurrent episodes of upper airway obstruction during sleep. The symptoms include loud snoring and difficulty in breathing, which lead to drops in blood oxygen levels and sleep disruption. Sleep apnoea affects more men than women and is common in people who are overweight as well as those who are older. People who have physical traits such as a large neck, low-lying soft palate, enlarged tonsils and small jaw with receding chin are also more susceptible to the condition.

Teo Kian Nguan

Communications Department

Email: teo.kian.nguan@sgh.com.sg