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Review
. 2021 Feb 9;18(4):1642.
doi: 10.3390/ijerph18041642.

The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea-A Literature Review

Saif Mashaqi  1 , Salma Imran Patel  1 , Daniel Combs  2 , Lauren Estep  1 , Sonia Helmick  1 , Joan Machamer  1 , Sairam Parthasarathy  1
Affiliations
Review

The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea-A Literature Review

Saif Mashaqi et al. Int J Environ Res Public Health. .

Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder that affects all age groups and is associated with many co-morbid diseases (especially cardiovascular diseases). Continuous positive airway pressure (CPAP) is the gold standard for treating OSA. However, adherence to PAP therapy has been a major challenge with an estimated adherence between 20% and 80%. Mandibular advancement devices (MAD) are a good alternative option if used in the appropriate patient. MAD are most effective in mild and moderate OSA but not severe OSA. Surgical options are invasive, not appropriate for severe OSA, and associated with pain and long healing time. Hypoglossal nerve stimulation (HGNS), or upper airway stimulation (UAS), is a novel therapy in treating moderate and severe degrees of OSA in patients who cannot tolerate CPAP therapy. We reviewed the MEDLINE (PubMed) database. The search process yielded 303 articles; 31 met the inclusion and exclusion criteria and were included. We concluded that hypoglossal nerve stimulation is a very effective and novel alternative therapy for moderate and severe OSA in patients who cannot tolerate CPAP therapy. Adherence to HGNS is superior to CPAP. However, more developments are needed to ensure the highest safety profile.

Keywords: BMI; CPAP; DISE; Inspire; children; complete concentric collapse; genioglossus; hypoglossal nerve stimulation; obstructive sleep apnea.

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Conflict of interest statement

The authors declare no conflict of interest related to this review.

Figures

Figure 1
Figure 1
Apnex Medical Inc. (St. Paul, MN, USA).
Figure 2
Figure 2
ImThera aura6000 (San Diego, CA, USA).
Figure 3
Figure 3
The Inspire system (Maple Grove, MN, USA).
Figure 4
Figure 4
The Inspire generator.
Figure 5
Figure 5
The Inspire respiratory sensing lead.
Figure 6
Figure 6
The Inspire stimulation lead.
Figure 7
Figure 7
The Inspire remote.
Figure 8
Figure 8
The Inspire programmer.
Figure 9
Figure 9
The neck incision (placing the cuff around the hypoglossal nerve). The steps of placing the cuff around the hypoglossal nerve 1–4.
Figure 10
Figure 10
A sagittal section in the head showing the intrinsic and extrinsic muscles of the tongue and their role in the protrusion and retraction of the tongue in addition to the opening of the retropalatal and hypopharyngeal space via palatoglossus coupling. (L) and (M) are the lateral and medial branches of the hypoglossal nerve, respectively.
Figure 11
Figure 11
The Genio system. (a) The implanted stimulator straddling the genioglossus muscles and hypoglossal nerve branches bilaterally and (b) the disposable patch and activation unit.
See this image and copyright information in PMC

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