Stale Nordgard et al. Otolaryngology – Head and Neck Surgery (2006) 134,565-570

This study attemtpted to improve patient selection for the Pillar Implant System using pressure recordings in the throat during sleep.

What is my take on this?

Based on this study, I cannot recommend the pillar implant system as a means to treat sleep apnea on its own but it may be used on its own to treat snoring.  The pros of the procedure are definitely the simplicity, ease of insertion, and lack of discomfort, and safety.  The cons are the variability of the results in a patient with sleep apnea and cost of the procedure. 

Although most people were satisfied with this procedure, what I found most concerning was the variable response in patients with sleep apnea despite doing everything possible to properly select patients.  They did more than what is done in my clinic by measuring airway pressures during sleep. 

Summary:
This study followed 25 patients with mild to moderate sleep apnea and were not overweight.  A pressure reading was taken during sleeping which helps determine the site of airway obstruction.  Any patient with more than ½ of obstructive events occurring at the base of tongue were excluded.  Three implants were inserted in each patient.  A repeat sleep study was done 3 months after the implantation.

Results:
Most patients showed improvement in sleep apnea and snoring.  The snoring intensity was ranked from 1 to 10.  Before implants, the average snoring was 8.4/10 (real bad).  After implants, the average snoring was 4.3/10 (moderate).  This was a subjective ranking by the patient’s bed partner.

The patient sleepiness using the Epworth Sleepiness Scale went from an average of 9.7 before implants to 5.5 after.  This is a measure of subjective sleepiness based on a survey filled out by patients.

The average AHI (Apnea Hypopnea Index) before implants was 16.2.  After implants the average was 12.1.  There were 6 out of 25 patients (24%) whose AHI remained unchanged or may have worsened after treatment.  In restrospect, there was nothing on history or physical exam that could predict who might get worse after. 

Complications: 
There were 2 out of 25 patients (8%) had one of their implants extrude (come out).  This occurred within 3 months of the procedure. There were no other complications.

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