Hypoglossal Nerve Stimulation

Hypoglossal nerve stimulation is a newer treatment for obstructive sleep apnea that involves surgery to place a device inside the body.  The throat is somewhat similar to a tube (for breathing, speaking, and swallowing) that is surrounded by muscles.  During sleep, muscles in the body relax, creating a situation where there can be blockage of breathing in the throat.  The hypoglossal nerve is the main nerve that controls tongue movement, and stimulation of this nerve can move the tongue forward, opening the space for breathing in the throat.

The only hypoglossal nerve stimulation system that is approved for sale in the United States by the Food and Drug Administration is Upper Airway Stimulation from Inspire Medical Systems.  There are four parts to the system.  The implanted pulse generator is the main unit, somewhat similar to a pacemaker, that delivers the stimulation signal to the hypoglossal nerve through a stimulation lead.  There is a sensing lead that measures breathing patterns so that the system sends the signal to move the tongue forward when a patient is breathing in, which is when they need to open the space for breathing.  The final part of the system is a remote control that allows a patient to adjust the system slightly and turn the system on and off as well as pause it so that it is working only when someone is sleeping.

Studies have shown that patients with sleep apnea who respond best to Upper Airway Stimulation share some characteristics: body mass index no greater than 32 kg/m2 and certain findings on a short evaluation procedure called drug-induced sleep endoscopy.  Body mass index is a measure reflecting body weight and height, and a value of 32 is approximately 235 pounds for someone who is 6 feet tall.  Drug-induced sleep endoscopy is performed in the operating room, with the goal of learning more about what is causing blockage of breathing in the throat in someone with obstructive sleep apnea.

Eric Kezirian, MD, MPH

Inspire and Upper Airway Stimulation are trademarks of Inspire Medical Systems, who is not affiliated with this website.

 

 

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