Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation

Arie Oliven

Disclosures

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

In This Article

Conclusion

To the present time, approximately 70 OSA patients have been treated with unilateral hypoglossus nerve stimulators. Overall, the results can be considered promising: substantial reductions in AHI, associated with improved oxygenation, and of subjective parameters have been demonstrated in adequately selected patients. Although general anesthesia is required, the operative procedures are performed subcutaneously, and all patients are mobile within a few hours after implantation. Few major adverse events requiring removal of the implants occurred, and none resulted in permanent morbidity. The implanted devices were well tolerated by the patients, resulting in good adherence to regular use of the stimulator on a nightly basis by responders, suggesting the possibility of a clear advantage compared to CPAP in some patients. The convenience of use may compensate for the cost and invasiveness of the procedure, thus providing an effective treatment modality for the population of OSA patients who cannot tolerate CPAP. However, in contrast to CPAP, hypoglossus nerve stimulation in its current unilateral version provides only a partial reduction in AHI in most patients. Also, an acceptable trade-off may exist for those patients able to use CPAP for only part of the night: partial reduction in AHI for an entire night using hypoglossus nerve stimulation vs. normalization of AHI for only part of the night on CPAP. Nevertheless, many of the most severe OSA patients (i.e. those with AHI >50) are probably inadequate candidates as hypoglossus nerve stimulation will most likely not produce a fall in AHI to below 20/h. Additional parameters that may predict response and could then improve patient selection need to be determined in future studies. In addition, once long-term safety of unilateral hypoglossus nerve stimulation is confirmed, further development of bilateral HGNS technology will likely improve the mechanical efficiency of this technique and allow extension of this treatment modality to a greater range of patients.

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