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Case Reports
. 2024 Jun 1;20(6):999-1001.
doi: 10.5664/jcsm.11066.

Hypoglossal nerve stimulation over-titration

Melisa Chang  1   2 , Virginia Moore  1 , Kevin Eng  1   2 , Armand Ryden  1   2 , Michelle Zeidler  1   2
Affiliations
Case Reports

Hypoglossal nerve stimulation over-titration

Melisa Chang et al. J Clin Sleep Med. .

Abstract

This case report reviews worsening obstructive sleep apnea (OSA) events in a patient over-titrated with a hypoglossal nerve stimulator. A healthy 57-year-old man underwent hypoglossal nerve stimulator implantation for moderate OSA. During an in-laboratory hypoglossal nerve stimulator titration the patient had improvement of his OSA at 2.1 V. However, a further increase of voltage resulted in worsening of obstructive events. The pathophysiology behind this finding is unknown but may result from unfavorable changes in the upper anatomy due to higher energy delivered to the hypoglossal nerve and surrounding structures. This high energy may also lead to genioglossus muscle fatigue. This finding highlights the importance of hypoglossal nerve stimulation titration with a dedicated sleep study.

Citation: Chang M, Moore V, Eng K, Ryden A, Zeidler M. Hypoglossal nerve stimulation over-titration. J Clin Sleep Med. 2024;20(6):999-1001.

Keywords: CPAP intolerance; airway anatomy; hypoglossal nerve stimulation; obstructive sleep apnea; over-titration.

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Conflict of interest statement

All authors have approved the manuscript. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Five-minute epoch of non–rapid eye movement sleep with the hypoglossal nerve stimulator set at 2.1 V.
Figure 2
Figure 2. Five-minute epoch of non–rapid eye movement sleep with the hypoglossal nerve stimulator set at 2.2 V.
See this image and copyright information in PMC

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