Neurostimulation of the hypoglossal nerve as a salvage treatment option in obstructive sleep apnea for CPAP intolerance

Abstract

Obstructive sleep apnea (OSA) is characterized by repetitive breathing stops in sleep and leads to daytime sleepiness with higher risk of traffic accidents, more cardiovascular complications such as stroke, and to disturbed glucose metabolism. Standard treatment is positive airway pressure therapy but a relevant portion cannot tolerate that for life time usage. Besides dental appliances and classic sleep surgery like tonsillectomy with UPPP, neurostimulation of the hypoglossal nerve reaches high success rates in selected cases, even in patients with higher overweight and more severe OSA burden. There are several implants such as by ImThera and Inspire Medical which differ in evidence and technical issues. Most results exist for the later with strict selection criteria’s. Especially the exclusion of a complete concentric collapse at the soft palate during drug–induced sleep endoscopy leads to high rate of treatment responders. The cuff placement of the stimulation leads at the protruding branches of the hypoglossal nerve serves a promising tongue motion pattern which correlates with better reduction of apneas during sleep. The therapy adjustment of the electrode configuration and respiration sensing settings helps to ensure treatment success and high therapy adherence. This talk covers the neurostimulation treatment, the identification of candidates, implantation, therapy adjustment and setbacks. As a high-volume implant center, our experiences and academic projects are shared with the audience.