Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea.
BACKGROUND
Hypoglossal nerve stimulation has been demonstrated to relieve upper airway obstruction acutely, but its effect on obstructive sleep apnea is not known.


OBJECTIVE
To determine the response in obstructive sleep apnea to electrical stimulation of the hypoglossal nerve.


METHODS
Eight patients with obstructive sleep apnea were implanted with a device that stimulated the hypoglossal nerve unilaterally during inspiration. Sleep and breathing patterns were examined at baseline before implantation and after implantation at 1, 3, and 6 months and last follow-up.


RESULTS
Unilateral hypoglossal nerve stimulation decreased the severity of obstructive sleep apnea throughout the entire study period. Specifically, stimulation significantly reduced the mean apnea-hypopnea indices in non-rapid eye movement (mean +/- SD episodes per hour, 52.0 +/- 20.4 for baseline nights and 22.6 +/- 12.1 for stimulation nights; P<.001) and rapid eye movement (48.2 +/- 30.5 and 16.6 +/- 17.1, respectively; P<.001) sleep and reduced the severity of oxyhemoglobin desaturations. With improvement in sleep apnea, a trend toward deeper stages of non-rapid eye movement sleep was observed. Moreover, all patients tolerated long-term stimulation at night and did not experience any adverse effects from stimulation. Even after completing the study protocol, the 3 patients who remained free from stimulator malfunction continued to use this device as primary treatment.


CONCLUSIONS
The findings demonstrate the feasibility and therapeutic potential for hypoglossal nerve stimulation in obstructive sleep apnea.
Schwartz
A R
AR
Sleep Disorders Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Cir, Baltimore, MD 21224, USA. Schwartz@jhmi.edu
Bennett
M L
ML
Smith
P L
PL
De Backer
W
W
Hedner
J
J
Boudewyns
A
A
Van de Heyning
P
P
Ejnell
H
H
Hochban
W
W
Knaack
L
L
Podszus
T
T
Penzel
T
T
Peter
J H
JH
Goding
G S
GS
Erickson
D J
DJ
Testerman
R
R
Ottenhoff
F
F
Eisele
D W
DW
D000328:Adult; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007002:Hypoglossal Nerve / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010108:Oxyhemoglobins / Q000032:analysis; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012895:Sleep, REM
D010108:Oxyhemoglobins