Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation

Arie Oliven

Disclosures

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

In This Article

Initial Dilator Muscle Stimulation Attempts in Humans

Attempts to stimulate upper airway dilating muscles in OSA patients for therapeutic purpose have been undertaken ever since the physiological importance of these muscles' action began to be appreciated. Although anecdotal reports describing dilator muscle stimulation with intramuscular electrodes date back to the late 1970s,[22] the first published trial reported a significant reduction in apneas with sub-mental electrical stimulation.[23] However, sub-mental stimulation causes contraction of the plathysma, but does not move the tongue even with strong, painful stimulation,[24] and the original findings could not be duplicated in other centers.[22,25,26] Even in patients with OSA, this technique produced only small and inconsistent improvement in pharyngeal patency. Similarly, fine-wire electrodes placed under computed tomography (CT) guidance near an internal branch of the hypoglossus nerve[26] and stimulation of the genioglossus muscle with surface or intramuscular electrodes[27–29] were not found useful for clinical purposes: although improvements in flow mechanics could be demonstrated, adequate flow at ambient pressure was observed in only a few OSA patients, and the stimulation was found to result in arousal after only a few breaths.

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