Inspire® Upper Airway Stimulation (UAS)
Sleep Lab Titration Checklist – RPSGT Focused
Inspire® Upper Airway Stimulation (UAS)
A Practical, RPSGT-Focused Educational Review for Sleep Technologists
- Why Sleep Technologists Need to Understand Inspire Therapy
As Inspire® Upper Airway Stimulation becomes more widely used, sleep technologists increasingly encounter patients with implanted devices during:
- Diagnostic PSGs
- Titration studies
- Post-implant optimization studies
- Follow-up efficacy testing
Unlike PAP therapy, Inspire therapy requires a different mindset: the technologist is not titrating pressure, but observing physiologic response to neurostimulation, documenting events accurately, and assisting with therapy optimization.
Understanding how Inspire works, how it affects sleep architecture and respiratory events, and how it is evaluated in the lab is essential for accurate scoring and meaningful clinical outcomes.
- Mechanism of Action (Tech-Level Explanation)
Inspire is a form of hypoglossal nerve stimulation (HNS) designed to prevent upper airway collapse during sleep.
What the device does:
- Senses the patient’s respiratory effort via a sensing lead
- Delivers timed stimulation to the hypoglossal nerve
- Causes tongue protrusion and upper airway dilation during inspiration
- Reduces obstructive apneas, hypopneas, and flow limitation
What it does NOT do:
- It does not treat central sleep apnea
- It does not splint the airway like CPAP
- It does not eliminate the need for proper sleep staging and event scoring
- Patient Selection (Why Some Patients Respond and Others Don’t)
From a technologist’s perspective, candidate selection explains variability in outcomes.
Key selection factors you should know:
- Moderate to severe obstructive sleep apnea
- PAP intolerance or failure
- Limited central/mixed apnea burden
- No complete concentric collapse (CCC) at the soft palate on DISE
- Acceptable BMI and airway anatomy per current FDA labeling
💡 Why this matters to techs:
If a patient has residual events despite stimulation, this may reflect phenotype limitations, not poor study quality or poor scoring.
- Inspire Therapy in the Sleep Lab
4.1 Types of Sleep Studies Involving Inspire
Sleep technologists may encounter Inspire patients during:
- Baseline PSG (pre-implant)
- Standard diagnostic PSG
- Used to establish severity and event phenotype
- Scored using standard AASM rules
- Post-implant Activation (not usually a PSG)
- Typically performed in clinic
- Device turned on weeks after surgery
- No overnight monitoring at this stage
- Inspire Titration PSG (key technologist role)
This is where the sleep technologist plays a critical role.
- Inspire Titration PSG: What the Tech Actually Does
Purpose of the study:
- Optimize stimulation settings
- Assess reduction in obstructive events
- Evaluate sleep quality and comfort
- Identify residual events
During the study:
- The patient uses their Inspire remote to turn therapy ON
- Stimulation amplitude is not controlled by the tech
- Adjustments are made according to protocol (physician/device representative dependent)
Technologist responsibilities:
- Monitor airflow, effort, oxygenation, and arousals
- Observe for:
- Reduction in obstructive apneas
- Reduction in hypopneas
- Decreased snoring and flow limitation
- Document:
- Sleep stage–specific response
- Positional effects
- Arousal patterns
- Any stimulation-related discomfort or awakenings
📌 Important:
Unlike PAP titrations, you are not chasing a pressure goal. You are evaluating physiologic response.
- Scoring Considerations for RPSGTs
AASM Scoring Rules Still Apply
- Apneas and hypopneas are scored per standard AASM criteria
- Inspire does not change scoring definitions
Key nuances to watch:
- Residual hypopneas may persist even with effective stimulation
- Flow limitation patterns may change rather than disappear
- REM-related obstruction may respond differently
- Supine vs non-supine differences are common
Central events:
- Central apneas may become more apparent once obstruction is reduced
- Important to clearly classify events correctly
- Sleep Architecture and Inspire
Technologists often observe:
- Improved sleep continuity
- Reduced arousals related to obstruction
- Variable effects on REM sleep (patient-specific)
- Occasional stimulation-related microarousals early in therapy
These findings should be objectively documented, not assumed to be adverse.
- Safety and Patient Comfort (What Techs Should Document)
Common observations:
- Tongue movement or mild discomfort
- Transient awakenings related to stimulation
- Adjustment period effects
Rare but important to document:
- Persistent awakenings linked to stimulation
- Speech or swallowing complaints during wake
- Patient inability to tolerate stimulation overnight
Your documentation directly impacts post-study programming decisions.
- How Inspire Outcomes Are Evaluated
Objective outcomes:
- AHI reduction
- ODI improvement
- SpO₂ nadir improvement
- Reduced time spent with obstruction
Subjective outcomes:
- Patient-reported sleep quality
- Reduced daytime sleepiness (ESS)
- Improved tolerance compared to PAP
Technologists support these outcomes by accurate staging, event scoring, and documentation.
- Limitations Techs Should Understand
- Inspire does not eliminate all respiratory events
- Some patients remain partial responders
- Weight changes, sleep position, and sleep stage affect efficacy
- Ongoing follow-up and optimization are expected
This is not a failure of therapy — it is part of long-term management.
- Practical Takeaways for RPSGTs
- Inspire therapy is not CPAP — adjust expectations
- Accurate scoring is critical for clinical decision-making
- Document stimulation effects clearly
- Understand patient phenotype and candidacy
- Your observations directly influence therapy optimization
Recommended Professional Disclaimer (Forum Use)
For Sleep Technologists:
This material is intended for professional education only and does not replace clinical judgment, physician oversight, or device-specific protocols. Inspire® therapy management and programming decisions are made by qualified providers in accordance with FDA labeling and institutional policy.
Final verdict
✔ Highly appropriate for RPSGT education
✔ Lab-focused and operationally relevant
✔ Accurate and aligned with AASM practice
✔ Excellent forum content for techs
🔹 PRE-STUDY CHECK (Before Lights Out)
☐ Confirm patient has Inspire device implanted
☐ Verify device activation date (therapy ON, not first activation night)
☐ Confirm patient brought Inspire remote
☐ Review study order (titration / efficacy / follow-up PSG)
☐ Confirm no CPAP/BiPAP will be used unless ordered
☐ Review prior PSG results (AHI, REM-related events, positional dependency)
☐ Document baseline complaints (sleep quality, discomfort, prior Inspire issues)
🔹 SETUP & SIGNAL QUALITY
☐ Standard PSG montage per AASM
☐ Ensure high-quality airflow (pressure transducer preferred)
☐ Confirm accurate effort belts (important for residual event classification)
☐ Optimize SpO₂ signal
☐ Audio/video recording ON (important for snoring & arousals)
🔹 THERAPY INITIATION
☐ Patient activates Inspire therapy using remote
☐ Document time therapy turned ON
☐ Note any immediate discomfort or awakenings
☐ Confirm therapy remains ON throughout the night unless instructed otherwise
📌 Important:
Technologists do not control stimulation amplitude unless protocol explicitly allows it.
🔹 DURING THE STUDY – WHAT TO MONITOR
☐ Reduction in obstructive apneas
☐ Reduction in hypopneas
☐ Changes in snoring and flow limitation
☐ Oxygen saturation trends
☐ Sleep architecture changes
☐ REM-related obstruction
☐ Positional differences (supine vs non-supine)
☐ Arousals related to:
- Obstruction
- Stimulation discomfort
- Position change
🔹 EVENT SCORING REMINDERS
☐ Score apneas & hypopneas per standard AASM criteria
☐ Inspire therapy does NOT change event definitions
☐ Carefully distinguish:
- Obstructive vs central events
- Residual hypopneas vs arousal-related breathing changes
🔹 PATIENT COMFORT & SAFETY DOCUMENTATION
☐ Tongue movement noted (expected)
☐ Mild discomfort (document severity & frequency)
☐ Persistent awakenings related to stimulation
☐ Patient requests therapy OFF (document reason & time)
☐ Any speech/swallowing complaints during wake
🔹 END OF STUDY DOCUMENTATION
☐ Total sleep time with Inspire ON
☐ AHI overall and by sleep stage
☐ Supine vs non-supine response
☐ REM response
☐ Oxygenation summary
☐ Patient tolerance summary
☐ Key observations for provider programming decisions
2️⃣ Sample CE Build
Inspire® Therapy for Sleep Technologists
Understanding Lab Titration, Scoring, and Clinical Impact
CE Level
Intermediate
Target Audience: RPSGTs, CPSGTs, sleep technologists
Course Description
This continuing education activity provides sleep technologists with a practical understanding of Inspire® Upper Airway Stimulation (UAS) therapy. Emphasis is placed on sleep lab workflows, Inspire titration PSGs, scoring considerations, and the technologist’s role in therapy optimization.
Learning Objectives
Upon completion of this activity, the participant will be able to:
- Describe the mechanism of action of Inspire® Upper Airway Stimulation
- Identify appropriate patient selection criteria for Inspire therapy
- Explain the role of the sleep technologist during Inspire titration PSGs
- Apply AASM scoring rules accurately in patients using Inspire therapy
- Recognize common lab findings, limitations, and safety considerations
Educational Content Outline
Module 1: Overview of Inspire Therapy
- What Inspire is and how it works
- How it differs from PAP therapy
- Indications and contraindications
Module 2: Inspire in the Sleep Lab
- Types of studies involving Inspire
- Pre-implant vs post-implant studies
- Inspire titration PSG goals
Module 3: Technologist Responsibilities
- Therapy activation and documentation
- What technologists can and cannot adjust
- Importance of detailed observation
Module 4: Scoring Considerations
- Standard AASM scoring rules
- Residual events and REM/positional effects
- Central events after obstruction improves
Module 5: Safety, Comfort, and Limitations
- Common patient experiences
- When to escalate concerns
- Long-term optimization expectations
Post-Test (Sample – 10 Questions)
- Inspire therapy primarily treats which type of sleep apnea?
A. Central
B. Mixed
C. Obstructive ✅
D. Treatment-emergent - Which structure is directly stimulated by Inspire therapy?
A. Phrenic nerve
B. Hypoglossal nerve ✅
C. Vagus nerve
D. Glossopharyngeal nerve - During an Inspire titration PSG, the technologist:
A. Adjusts stimulation amplitude
B. Adjusts pressure settings
C. Observes physiologic response ✅
D. Turns therapy off after REM - Inspire therapy changes AASM scoring rules.
A. True
B. False ✅ - Which evaluation is used to rule out complete concentric collapse?
A. MSLT
B. CPAP titration
C. DISE ✅
D. Actigraphy - Residual hypopneas during Inspire therapy:
A. Always indicate failure
B. Are common and patient-specific ✅
C. Should be ignored
D. Are central by definition - Inspire therapy is best described as:
A. Pneumatic splinting
B. Surgical airway bypass
C. Neurostimulation-based therapy ✅
D. Oxygen therapy - Which finding should always be documented?
A. Tongue movement
B. Patient discomfort
C. Arousals
D. All of the above ✅ - Inspire therapy eliminates the need for follow-up.
A. True
B. False ✅ - The technologist’s documentation primarily helps:
A. Billing
B. Device programming decisions ✅
C. Marketing
D. Surgical planning
CE Disclaimer
This educational activity is intended for professional education only and does not replace physician oversight, institutional protocols, or device-specific training. Inspire® therapy management decisions are made by qualified providers.