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. 2021 Mar;25(1):425-431.
doi: 10.1007/s11325-020-02112-2. Epub 2020 Jun 2.

Cross motor innervation of the hypoglossal nerve-a pilot study of predictors for successful opening of the soft palate

Clemens Heiser  1   2   3 , Olivier M Vanderveken  4   5 , Günther M Edenharter  6 , Benedikt Hofauer  7
Affiliations

Cross motor innervation of the hypoglossal nerve-a pilot study of predictors for successful opening of the soft palate

Clemens Heiser et al. Sleep Breath. 2021 Mar.

Abstract

Purpose: Selective hypoglossal nerve stimulation has proven to be a successful treatment option in patients with obstructive sleep apnea. The aim of this pilot study was to investigate if there is a cross-innervation of the hypoglossal nerve in humans and if patients with this phenotype show a different response to hypoglossal nerve stimulation compared to those with ipsilateral-only innervation METHODS: Nineteen patients who previously received a selective hypoglossal nerve stimulation system (Inspire Medical Systems, Golden Valley, USA) were implanted with a nerve integrity system placing electrodes on both sides of the tongue. Tongue motions were recorded one and two months after surgery from transoral and transnasal views. Polysomnography (PSG) was also performed at two months. Electromyogram (EMG) signals and tongue motions after activation were compared with PSG findings.

Results: Cross-innervation showed significant correlation with bilateral tongue movement and bilateral tongue base opening, which were associated with better PSG outcomes.

Conclusion: Cross motor innervation of the hypoglossal nerve occurs in approximately 50% of humans, which is associated with a positive effect on PSG outcomes. Bilateral stimulation of the hypoglossal nerve may be a solution for non-responding patients with pronounced collapse at the soft palate during drug-induced sleep endoscopy.

Keywords: Cross motor innervation; Hypoglossal nerve; Hypoglossal nerve stimulation; Obstructive sleep apnea; Upper airway stimulation.

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Conflict of interest statement

Clemens Heiser is a consultant for Inspire Medical Systems and received consultancy fees, reimbursement of conference fees, and travel and accommodation expenses from Neuwirth Medical Products, Löwenstein, and Sutter Medizintechnik. Furthermore, he is a consultant and on the advisory board of Galvani.

Olivier Vanderveken has the following potential conflicts of interest related to the topic of the manuscript: research support and lecture fees from Inspire Medical Systems, research grant from and consultancy for Philips Respironics, research grant and lecture fees from Somnomed, consultancy for Nyxoah, research support from ReVent, research support from Nightbalance.

Benedikt Hofauer received personal fees and travel expenses from Inspire Medical Systems.

Günther Edenharter has no conflict of interest.

Figures

Fig. 1
Fig. 1
The percentage of patients with tongue motions at months one and two after implantation of the system. Bi bilateral protrusion, Rp right protrusion, M1 month 1, M2 month 2
Fig. 2
Fig. 2
The percentage of patients with motions at the tongue base and calculated PGC effect at the retropalatal region at months one and two after implantation of the system. PGC effect was calculated and coded with: no = no enlargement at the soft palate, some = some enlargement at the soft palate, and large = marked enlargement at the soft palate.bi bilateral protrusion, ip ipsilateral protrusion, PGC palatoglossus coupling, M1 month 1, M2 month 2
Fig. 3
Fig. 3
Correlation between tongue motion and innervation of the hypoglossal nerve.The bubble plot illustrates the correlation of the type of innervation and the tongue motion at M2. A strong correlation between a cross-innervation and a bilateral tongue protrusion was detected
See this image and copyright information in PMC

References

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