Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation

Arie Oliven

Disclosures

Curr Opin Pulm Med. 2011;17(6):419-424. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent pharyngeal collapse secondary to sleep-induced hypotonia of peri-pharyngeal structures. Therapy for OSA is sometimes poorly tolerated and not always effective. The current study reviews a new treatment modality, hypoglossus stimulation, recently evaluated by multiple physiological studies and currently assessed by several clinical studies.
Recent findings A phase-I, implantable hypoglossus nerve stimulation multicenter study was published in 2001. Significant reduction in apnea–hypopnea index (AHI) was reported in seven of the eight implanted OSA patients, but technical faults precluded prolonged follow-up. Over the past 2 years, three new hypoglossus nerve stimulation systems have been evaluated in more than 60 OSA patients. In adequately selected patients, a more than 50% reduction in AHI was observed. Usually, a decrease in OSA severity from moderate–severe to mild–minimal can be achieved.
Summary Ongoing research, including recent initiation of a large multicenter phase-III study, suggests that hypoglossus nerve stimulators are likely to be available as a new treatment modality within a few years. Additional data are needed to define which OSA patients are most likely to benefit from hypoglossus nerve stimulation. Continuous refinement of electrodes design is likely to improve stimulation efficacy in coming years.

Introduction

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of upper airway obstruction during sleep.[1,2] In addition, OSA has been shown to increase the risk of hypertension and metabolic disorders, and consequently cardiovascular morbidity and mortality.[3–7] Although numerous methods have been used to restore upper airway patency during sleep, no single treatment modality has been shown to provide relief to all patients with this disorder, as all are only partially effective and/or may be poorly tolerated: continuous positive airway pressure (CPAP) has been the mainstay of treatment since the early 1980s, but incomplete compliance persists despite continuous technical improvements. A large number of oral appliances and operative solutions have been designed, but at times only partial improvement can be achieved.[8–11] Therefore, a new approach to the treatment of OSA is most desirable, preferentially an approach that will address the primary cause of pharyngeal obstruction in OSA, namely, the sleep-related decrease in pharyngeal dilating forces.

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