The Quest for Unobstructed Sleep: Q and A With Sleep Surgeon Dr. Maria Suurna
The director of sleep surgery at the University of Miami Miller School of Medicine says it’s an exciting time to be working in her specialty.
While solutions for obstructive sleep apnea have traditionally been limited, the field is undergoing a significant shift. Recent advances are bringing new technologies and innovations to the forefront, led by experts like Maria Suurna, M.D., professor of clinical otolaryngology–head and neck surgery and director of sleep surgery at the University of Miami Miller School of Medicine.
Dr. Suurna is a leading expert in the field of sleep surgery, focusing on patients with obstructive sleep apnea who have not benefited from non-surgical treatments. We spoke with her about the current state of sleep apnea, available treatments and the future of the field.
Talk about the current state of sleep apnea and how the field has progressed.
Today, the field of sleep medicine is still relatively under-researched, with many unknowns, but the opportunities for advancement are vast. There is significant potential for discovery, especially with the continued development of new technologies.
One major innovation is the ability for patients to monitor and record their sleep patterns at home. This technology helps both patients and health care providers better understand what happens during sleep, leading to more accurate diagnoses and personalized treatment plans. As awareness grows among patients, the medical community is also paying closer attention to sleep disorders.
How do you approach treatment for obstructive sleep apnea?
My initial approach begins by talking with the patient, preferably involving their bed partner or a family member, to get a full understanding of the main problems they’re experiencing. Afterward, a sleep study is typically performed, either at home or in a lab. This diagnostic tool helps assess the quality of sleep, detect airway obstructions and evaluate any drops in oxygen levels during sleep, as this can have long-term health implications beyond just snoring or airway collapse.
Once a diagnosis is made, whether mild, moderate or severe, I then evaluate the patient’s airway to identify any obvious anatomical factors contributing to the sleep issues. Occasionally, in patients who experience a sudden change in breathing patterns or snoring, we may find unexpected causes, such as lesions, nasal polyps or tumors.
After thoroughly evaluating the airway and confirming the diagnosis, I discuss personalized treatment options with the patient.
What are the treatment options for obstructive sleep apnea?
There is no one perfect treatment for sleep apnea, as each option has its pros and cons. Initial treatment often begins with CPAP because it keeps the airway open during sleep by providing continuous positive airway pressure, essentially blowing air into the airway to prevent collapse.
Dental oral appliances work by moving the jaw forward, which in turn pulls the tongue forward, stabilizing and opening the airway. While these can be effective, they may not work for everyone and depend on the individual’s anatomy.
Nasal dilators can help people who struggle to breathe through their noses by preventing nasal obstruction. While they don’t directly treat sleep apnea, they can improve nasal air flow, which is important for reducing airway resistance.
You’re an advocate for the use of neurostimulation as a therapy. What can you tell us about this technology and its effect?
For the past decade I have been offering neurostimulation therapy for patients with moderate-to-severe sleep apnea who are not significantly overweight and have already tried and failed CPAP treatment. The concept behind neurostimulation is based on improving the neuromuscular tone and opening of the airway during sleep.
In many patients, the loss of muscle tone leads to the airway obstruction, as the base of the tongue collapses and the muscles that normally keep the airway open become weaker. A surgically implanted neurostimulation device works by stimulating the hypoglossal nerve, which controls the muscles of the tongue and airway. By stimulating this nerve, the device restores muscle tone and helps protrude the base of the tongue forward, preventing it from collapsing during sleep. This reestablishes airway stability, reducing or eliminating the obstruction that leads to sleep apnea.
What research are you currently working on?
For many years, I’ve been involved in clinical trials specifically focused on alternative treatment options to obstructive sleep apnea. One area of interest is neurostimulation devices. Currently, there is an FDA-approved neurostimulation device that is commercially available, but there are also other devices undergoing clinical trials in the U.S. These trials are looking at other neurostimulation approaches, including bilateral hypoglossal neurostimulation for patients who do not meet the criteria for the existing, FDA-approved devices, often due to anatomical differences related to airway obstruction.
Another area of research we’re focusing on is cryolipolysis, which involves cooling tissues in the airway to reduce the fat volume, specifically targeting the base of the tongue and palate to potentially resolve sleep apnea over the long term. There are also several other promising therapies on the horizon and we are in the early stages of designing new treatments.
Our goal is to address airway collapse in the least-invasive way, particularly for patients who are unable to benefit from CPAP therapy.
What does the future of sleep medicine look like?
I believe sleep medicine is a field that will continue to expand. There is still so much we don’t fully understand, not just about sleep apnea, but also about conditions like insomnia, parasomnias and even leg movement disorders during sleep.
Many patients present with sleep issues beyond sleep apnea, and we lack a complete understanding of the pathophysiology of sleep itself—how it works, why it’s important and how different conditions impact it. We’re seeing progress in management of various sleep disorders. In addition to technological advances, there are also new medications emerging, particularly for managing weight and restoring neuromuscular tone, both of which play roles in sleep health.
This is an exciting time for the field, and I expect to see a lot more developments that will improve patient care and outcomes in the future.
Tags: Dr. Maria Suurna, obstructive sleep apnea, otolaryngology, sleep, sleep apnea, sleep disorders, sleep medicine