**EP407: The Complexity of OSA with Kirk Huntsman**
**Dr. Warwick:** Hi, Dr. Warwick here and welcome to my podcast and videocast station. I'm delighted today to actually have Kirk Huntsman with me. It's actually taken a while to line this up, so I'm super excited. Kirk is a businessman, an entrepreneur who's been in the space for over 30 years, and he's linked with Vivos Therapeutics, which developed devices for obstructive sleep apnea, which is hugely important. I'm really very, very happy to have the chance, very privileged to have the chance to have someone from the other side of the world, an expert in the space, talk about this really, really important issue. G'day, Kirk. How are you?
**Kirk Huntsman:** I'm fine, thanks. Appreciate being here, Warwick. I'm looking forward to this.
**Dr. Warwick:** Look, I do too. I think obstructive sleep apnea is a massive issue. I keep up with the general literature as best I can, but I had some stuff come across my desk the other day, which really focused my mind on the importance of what it was talking about—cognitive decline with obstructive sleep apnea. Now, I know you're a businessman, but I know that you're behind a company trying to make a difference in your own sort of experience. What are the things that you really think obstructive sleep apnea is driving, and why should we be aware of it?
**Kirk Huntsman:** Well, let's talk a little bit about the prevalence of this disorder and sort of what it does. The current estimates are that over a billion people on planet Earth have obstructive sleep apnea or a related sleep disorder. When you think about that, that's one out of every eight. So we're talking about men, women, children. A lot of people don't realize that obstructive sleep apnea can affect very young children all the way up to very old people. It spans the course of a lifetime. It transcends ethnicities and national boundaries. It's not just a disease that afflicts, you know, it used to be thought that there was a stereotype around obstructive sleep apnea that it only afflicted overweight males in their 40s or some such. We now know obstructive sleep apnea is a condition that can affect anyone at any stage of their life. It begins at the earliest stages of life and, if not diagnosed or corrected early on, can actually plague someone throughout their entire life and manifest with more and more severity as we age.
**Dr. Warwick:** Yeah, this is a big deal, and you are very right to call it a really big deal because what we know about sleep apnea today that we didn't know even 10 or 15 years ago is that this disorder will actually take years off of our lives, especially in its moderate to severe range. When you talk about moderate to severe sleep apnea, you're really talking about something that has the ability to not only end our lives early but also make our lives more complicated, more debilitated. The reason we came up with the name Vivos for our company is because people with sleep apnea, during the daytime, they're never fully awake, and at nighttime, they're never fully asleep. So they're never fully alive. Vivos is a sort of a quasi Latin Spanish term that means to be alive, right? The living. We want people to breathe fully and cleanly so that they can be fully alive.
**Kirk Huntsman:** Our firm's mission is to bring awareness to the world about this disorder and to actually bring products to the market that are shown and proven to address some of these disorders at their root cause. We actually have a line of oral appliances that help remodel a human airway non-surgically, opening it up so that people can breathe and sleep without having it collapse. So that's what we do.
**Dr. Warwick:** Okay, fantastic. I guess one of the really important things, if we're talking about one in eight people, is what I'd be really interested in sharing—some of the things that those people listening to this should be on the lookout for, either in themselves or their loved ones, which could be a sign that they're suffering or their family or friends are suffering poor sleep. A quick story: when I was a trainee many years ago, I worked on a sleep apnea unit where they bring people in for testing. I remember clearly talking to this big man—actually, he did probably fit the stereotype because he was carrying extra weight. As I spoke with him, I said, "How did you end up in the unit?" He said he used to find that he would get sleepy and lean into corners and have a quick nap during the day. As he was doing this at a party, someone came up to him and said, "Oh, I had a brother who did that, and he had sleep apnea. You should go and get checked." So this guy was literally standing on his feet, having a quick nap. He admitted that he'd look at a wall and think, "Oh, that looks comfortable," nuzzle in there for a moment, and have a sleep. So that's extreme. But what are the things that people should be looking for, Kirk, if they're going to try and evaluate their sleep?
**Kirk Huntsman:** I think you touched on one of them, right? Excessive daytime drowsiness is a primary condition associated with sleep apnea. We're looking at people who, when they wake up in the morning, they don't feel refreshed. The sheets may be all over the place because they've had some restless leg syndrome throughout the night. They probably had interrupted sleep. If their bed partner has heard them snoring, snoring is associated with sleep. We know that in men, a neck size in the United States of 17 inches— you'll have to translate that into centimeters— is associated with a 96 percent correlation with sleep apnea, and 14 inches in females. Those are correlations to look for. If people have a narrow upper palate, if they have a high peaked palate that extends up into their nasal passages rather than a Roman arch up there, that can be a sign.
We're supposed to have a Roman arch, and our tongue is supposed to be the scaffolding that holds it up. But if the tongue is either because of a short frenulum or some other condition where that tongue is not up and forward to hold that up there, the dental arch will collapse and impede on the nasal breathing capabilities and capacity of the patient. So we have conditions where if you have crooked crowded teeth with a narrow upper palate, if you have tori, which are bony protrusions in the lower or upper palate, if you have eyes that are not level or you have ear issues, and finally, if your posture is off, you probably have a condition associated with obstructive sleep apnea.
Today, what's really important for your listeners to understand is that it is so easy for a test to be done. It used to be that they had to go to a sleep clinic and spend the night and get a polysomnogram and all that. Nowadays, it can be done in the comfort of their home with a home sleep test device. Once you get that sleep test read by a properly qualified physician, then you can decide what kind of treatment you want.
Forty-five years ago, out of Australia came the CPAP. Love it or hate it, you guys delivered to the world what has been the gold standard for obstructive sleep apnea. I believe the guy's name was Dr. Sullivan, and he came forward with this CPAP device, showing the world how to really at least give patients an opportunity to manage this condition. What our firm has done is develop products that actually seek to resolve the condition. So rather than have a CPAP device every night for the rest of your life, you go into a treatment with our devices, our oral appliances, and within nine to 12 months, you've got a big new set of pipes that we've created by repositioning some of the tissues that define the airway. There are new technologies out there that give patients options rather than just sort of everybody gets a CPAP. That's been really the reality for OSA patients for the last 40 years.
**Dr. Warwick:** So that remodeling of the upper airway that you're talking about— is that guided generally by a dentist or someone who's got experience in upper airway anatomy? Is that how that works?
**Kirk Huntsman:** Yeah, it would be a specially trained dentist who could do this. You asked me earlier if there were some dentists in Australia that would serve the needs. Yeah, there are. I probably don't know if you want me to mention their names or not, but there are dentists in Australia.
**Dr. Warwick:** Probably the easiest way to find them is on your website. Is there a link to dentists on the Vivos Therapeutics website?
**Kirk Huntsman:** No, we really don't put that out there because we had some problems with some people misusing and abusing that service. But if they will call our help desk number on our website, our people will be able to refer them to qualified practitioners. We might have one in Perth, but I think most of them are in Sydney or Melbourne.
**Dr. Warwick:** Okay, fantastic. So anyone listening who thinks this may be an important intervention for them and wants to explore it, check out the Vivos, V-I-V-O-S, Therapeutics website. As Kirk says, give them a call. There’s probably even an email, I'm imagining, and just ask to be directed to someone in the area who might be able to give an assessment and an appraisal.
That's fantastic. Look, jumping back to your comment about the diagnosis, are we seeing things like Apple phones and Android phones with sleep regulating or sleep assessment apps being helpful at all in diagnosing obstructive sleep apnea, or are they still not accurate enough?
**Kirk Huntsman:** I think the answer to that is absolutely yes. For what they're able to do, they're great screening devices. The data that comes out of them is not necessarily diagnostic grade or quality yet, but they are great at two things: screening for this condition and monitoring whether you're relatively better or worse as you go along. They serve a very important purpose and point you to the need for further evaluation. Some of these home sleep tests now are actually really highly accurate. Physicians can gain all the information they need to render a diagnosis, and then you can decide what sort of pathway you want to go down for treatment.
**Dr. Warwick:** One of my experiences with obstructive sleep apnea—obviously, I told you I worked in a sleep unit many years ago as part of a respiratory rotation—and I've not had a lot to do with it since. But my referrals these days have gone to respiratory physicians. I'm getting the sense that dentists, particularly with the ability to use the sort of devices that Vivos are producing, could be the solution for many of these individuals with OSA. Would that be a fair assessment?
**Kirk Huntsman:** I think that's a fair assessment. I would say this: if you're going to a dentist to get access to this technology, which is mediated through an oral appliance device, make sure that you are going to a dentist that has good experience and has done lots of these cases. Also, go under the care of a physician as well. I would hesitate—there are a lot of, especially in the dental field, a lot of guys that just don’t take the time to really do their education. They don’t really understand all of the different complexities that associate with this disorder. They may just have a simplified view of the world where they think they can do a quick test and then plug and play their little appliance and sort of wash their hands of it. That is really not what needs to be done here. This is a complex disorder. It's a life-threatening disorder in many cases. It's certainly a very debilitating disorder, and you really want to have the benefit of experience and knowledge when you go into this. Having the medical and dental team working with you is really important to emphasize.
**Dr. Warwick:** Yeah, that's really valuable insight, actually, Kirk. For those listening, and I know from my own experience, there are many people who get frustrated with the CPAP—the continuous positive airway pressure device. Not only does the patient find it frustrating, but so does their spouse because they get air blown in their face. There might be a conversation with your respiratory physician in combination with a dentist skilled in this area.
So we might get towards wrapping this up, Kirk. Was there anything in particular you wanted to highlight around obstructive sleep apnea?
**Kirk Huntsman:** I think the one in eight is fundamental to an awareness of just how broadly it affects the population and also the age range from young to old. I think this is something I wasn't even aware of. Anything else you'd like to highlight for our listeners?
**Kirk Huntsman:** Well, yeah, I think it's important for people to know that there's a CPAP route, right? There's the gold standard medical CPAP route. If you go down through the oral appliances, there are two fundamental types of appliances. One is a mandibular advancement device where they literally reposition the lower jaw forward, and you'll basically open your bite just a little bit. That's called a mandibular advancement appliance or MA. Sometimes they're called MAD devices.
But other times, the Vivos technology is the only device in the world that has FDA clearance to treat severe obstructive sleep apnea. All other devices, all other oral appliances, are only cleared for snoring and mild to moderate sleep apnea. Only the Vivos technology, which we call our care devices to rehabilitate and restore the airway, is cleared for severe. Patients just need to understand that there are choices and options. If you really want to get well, then you need to probably go upstream to the rehabilitate and restore devices.
The most important thing we can leave your listeners with today, though, is the need to get tested. Because of the simplicity and the great technology that's out there right now in home testing devices and services, there is no reason, as part of your annual physical, to not request a sleep test from your physician. They're easy to administer, they're covered by insurance, and they should be done by everybody—whether you're young or old, thin or heavy, male or female. You should get a sleep test to understand how well you're sleeping. When we do sleep tests here in the U.S., we see about half of the patients that perform a sleep test have sleep apnea.
Fifty percent of our population here in America—we eat too much, we don't exercise enough. There are all kinds of things about American society that lead to a higher incidence. But everybody throughout the world that has the resources and the ability to get sleep tested should do so. There's really no excuse any longer to do that. And you know that there are options beyond just wearing that mask. That's the key takeaway I hope everybody leaves with here today.
**Dr. Warwick:** Yeah, look, the other key takeaway that I'd like to underline is that prevalence, which is super important, and the age range. But the reason why you want to do something about it—this is a condition that affects your entire body. It increases the risk of cardiovascular disease, increases the risk of raised pulmonary pressures in your lungs. But that data that I saw recently—we're talking about cognitive impairment. This is going to accelerate the risk of Alzheimer's disease, early onset dementia, Alzheimer's—all of these neurocognitive, neurobehavioral type things. It's neurobehavioral in children, it's neurocognitive in adults. We start to lose our ability to cognitively process the world around us, and we do that at earlier ages when we have obstructive sleep apnea.
**Kirk Huntsman:** You bring on a great point. The comorbidities—it's not just the obstructive sleep apnea. It's what the obstructive sleep apnea does to make cardiovascular disease worse, diabetes worse. Cancer rates go up. There's not a single chronic condition of modern man that is not either caused by or made worse by the presence of obstructive sleep apnea. This is a major health concern that ought to be addressed by certainly every person in Western society where we have the access to the resources to test and to treat.
**Dr. Warwick:** 100%. And if anyone's thinking that, "Oh, that wouldn't happen to me," or "I won't get those medical consequences from it," it's closely linked to motor vehicle accidents as well. So even if the medical side of it doesn't get you, you may have an accident on the road through micro-sleeping and loss of attention. This is really a condition that, if you can sort it out, can have incredible change on people's lives and really make a significant difference—not just to quality of life, but health span. So please, yeah, please don't get caught snoring on the job when it comes to getting assessed for obstructive sleep apnea.
**Kirk Huntsman:** Absolutely.
**Dr. Warwick:** Kirk, I'm going to thank you enormously for joining me all the way from Denver, Colorado. It's been an absolute privilege to finally catch up. I know we've been trying to angle this for ages. I'm so stoked I've been able to get you on. Kirk Huntsman is CEO of Vivos Therapeutics. Vivos Therapeutics—don't forget, obstructive sleep apnea affects one in eight people. This is enormous. All ages. There are clues: big people, big necks, daytime somnolence. Maybe use your phone, check your phone if you've got an app for sleeping, see if there's a signal there. If your sleep looks perfect, you probably don't need a test. If you have any questions about your sleep, talk to your GP. Like Kirk said, everyone should be screened, and the conversations and the management are complex. Talk to your respiratory physician if you do seek out support from a dentist, and particularly want to improve the airways. Find someone who knows what they're doing. Reach out to Vivos Technology.
Kirk, thank you once more for joining me.
**Kirk Huntsman:** Thanks, Ward. Thanks for having me.
**Dr. Warwick:** For those listening, I really hope you found this as informative and interesting as I did. This is just such an important area, so I'm so glad to be able to get out there and get people thinking about it to hopefully do something about it. If you've got any queries or questions, drop us a note at info@droratebishop.online. Until next time, I hope you live as well as possible for as long as possible. Take care and bye for now.
