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Review
. 2025 Aug 4;14(15):5494.
doi: 10.3390/jcm14155494.

Review of Neurostimulation Therapies for Obstructive Sleep Apnea: Hypoglossal Nerve Stimulation and Beyond

Patrícia Dos Santos Cé  1 , Maria Eduarda Schiestl Melo  2 , Alan Alves Machado  2 , Sarah Eden Ridge  3 , Thomaz Fleury Curado  3
Affiliations
Review

Review of Neurostimulation Therapies for Obstructive Sleep Apnea: Hypoglossal Nerve Stimulation and Beyond

Patrícia Dos Santos Cé et al. J Clin Med. .

Abstract

Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder characterized by partial or complete obstruction of the upper airway, typically resulting in a decrease in arterial oxygen saturation and repeated awakenings from sleep. It is the most common sleep-related respiratory disorder, affecting 9% to 38% of adults. OSA is associated with loss of tone, improper contraction of the tongue, and pharyngeal dilator muscles of the upper airway during sleep. The gold-standard treatment for moderate-to-severe OSA is continuous positive airway pressure (CPAP). However, many patients have poor long-term compliance with CPAP. Stimulation of the upper airway with electrical activation of the hypoglossal nerve has emerged as a promising treatment for patients with moderate-to-severe OSA who have failed CPAP therapy. Objectives: The present paper aims to review the literature regarding neurostimulation for the treatment of OSA. Conclusions: Hypoglossal nerve stimulation (HNS) has shown favorable success and low morbidity in the management of moderate-to-severe OSA.

Keywords: airway management; hypoglossal nerve stimulation; obstructive sleep apnea.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Innervation of the upper airway.
Figure 2
Figure 2
A timeline of developments in upper airway neurostimulation.
Figure 3
Figure 3
Sequence of HNS implantation using the Inspire® system. Source: Archive of Thomaz Fleury, MD. (a) Identification of landmarks and incision planning. (b) Insertion of monitoring electrodes into the hyoglossus muscle. (c) Placing the cuff of the stimulation lead around the hypoglossal nerve. (d) Insertion of the sensing lead between the internal intercostal and external intercostal muscles. (e) Placing the implantable pulse generator into the subcutaneous pocket in the chest.
Figure 4
Figure 4
Prevalence of upper airway collapse patterns on drug-induced sleep endoscopy (DISE) and estimated rates of Inspire hypoglossal nerve stimulation success and failure for each pattern.
See this image and copyright information in PMC

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