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VA to offer new procedure to help Veterans with central sleep apnea

Veteran patient Ralph Kolesar gets amplitude of diaphragm stimulator adjusted
Veteran patient Ralph Kolesar gets amplitude of diaphragm stimulator adjusted during a routine follow-up appointment after undergoing a new procedure to help improve his centralized sleep apnea.

Veteran patient Ralph Kolesar was diagnosed with both obstructive and central sleep apnea in 2014. Since this diagnosis, he has been dependent upon his positive airway pressure (PAP) machine to help him better breath at night.

“Recently, my provider told me about a new procedure that the VA was doing and determined that I would be a good candidate for it. I think that I’m still adjusting to the device but overall, I am getting better quality sleep,“ Kolesar said.

Kolesar had a diaphragm stimulator implanted in September 2021 to help improve his quality of sleep and has been following up with his providers to ensure that he is healing well and to adjust the amplitude of the device.

“The diaphragm stimulator is a relatively new technology and is available to Veteran patients with moderate to severe central sleep apnea,” said Dr. Susheela Hadigal, Pulmonologist, North Florida/South Georgia Veterans Health System (NF/SGVHS). “Once the device is implanted, it takes about 6 weeks to study the patient’s sleep patterns and to appropriately activate the device.” 

According to the CDC, central sleep apnea is a serious breathing disorder that disrupts normal breathing patterns during sleep and has been shown to negatively impact quality of life and heart health.

“I am hopeful that I’ll permanently be off my PAP machine,” said Kolesar. “My CPAP machine has been my life support for so long…”

The diaphragm stimulator is an implantable device that simulates the phrenic nerve (nerve in the chest) to send signals to the diaphragm (the large muscle that controls breathing). The signals stimulate breathing in the same way that the brain stimulates breathing. The device works continuously and automatically monitors and stabilizes breathing patterns, restoring sleep throughout the night.   

“Veteran patients who experience difficulty sleeping are referred for a sleep study by their provider and the results of the sleep study help to determine whether a consult with cardiology should be made for the procedure,” said Hadigal.

Dr. Hadigal further explains that sufficient sleep is essential in maintaining a healthy lifestyle. Identifying the type of sleep apnea, the patient has is also an important step for treatment of the disease.

“There are two kinds of sleep apnea. Obstructive sleep apnea and central sleep apnea,” said Hadigal. “Obstructive sleep apnea indicates that there is an obstruction in the back of the throat or neck which can be from an anatomical defect or excess fat around the neck. Central sleep apnea occurs when the brain doesn’t send the proper signals to the muscle that controls breathing.”

NF/SGVHS, Cardiologist, Dr. Ramil Goel explains that signs of fragmented sleep patterns, not breathing for a few seconds, or if the patient experiences interrupted sleep may all be symptoms of central sleep apnea.

“The sleep study helps us to confirm the patient’s diagnosis and helps in determining if a referral to cardiology is warranted,” said Goel.

Further assessment of the patient through a series of screenings by cardiology then takes place.

“Screenings include a frailty screening which picks out patients who might not do well during surgery, determining whether the patient has had prior devices implanted such as a cardiac pacemaker, and conducting an in-depth examination of the patient’s previous cardiac surgeries, if any.”

If the patient is a candidate for the procedure, cardiologists will explain the risks and benefits to the Veteran and the procedure is scheduled.

“Typically, the procedure is done in the morning and the patient is monitored overnight,” said Goel. “If they are doing well, they are released the following morning and are scheduled for a follow-up appointment a week later to ensure that everything is healing well.

To date, NF/SGVHS has experienced tremendous success in helping Veterans overcome health related challenges due to CSA. Interested Veterans should consult their primary care or lung/sleep physician to inquire about the procedure.

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