title: Origins of and implementation concepts for upper airway stimulation therapy for obstructive sleep apnea.
abstract: Upper airway stimulation, specifically hypoglossal (CN XII) nerve stimulation, is a new, alternative therapy for patients with obstructive sleep apnea hypopnea syndrome who cannot tolerate positive airway pressure, the first-line therapy for symptomatic patients. Stimulation therapy addresses the cause of inadequate upper airway muscle activation for nasopharyngeal and oropharyngeal airway collapse during sleep. The purpose of this report is to outline the development of this first-in-class therapy and its clinical implementation. Another practical theme is assessment of the features for considering a surgically implanted device and the insight as to how both clinical and endoscopic criteria increase the likelihood of safe and durable outcomes for an implant and how to more generally plan for management of CPAP-intolerant patients. A third theme is the team building required among sleep medicine and surgical specialties in the provision of individualized neurostimulation therapy.
authors.affiliation: Departments of Medicine and Otolaryngology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: kpstrohl@aol.com.
authors.forename: Kingman P
authors.initials: KP
authors.lastname: Strohl M D
authors.affiliation: Departments of Medicine and Otolaryngology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: Jonathan.Baskin2@uhhospitals.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Baskin M D
authors.affiliation: Departments of Medicine and Otolaryngology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: Colleen.Lance@uhhospitals.org.
authors.forename: Colleen
authors.initials: C
authors.lastname: Lance M D
authors.affiliation: Departments of Medicine and Otolaryngology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: Diana.Ponsky@uhhospitals.org.
authors.forename: Diana
authors.initials: D
authors.lastname: Ponsky M D
authors.affiliation: Departments of Medicine and Otolaryngology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: Mark.Weidenbecher@uhhospitals.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Weidenbecher M D
authors.affiliation: Case School of Medicine, Cleveland, OH, USA. Electronic address: madeleinestrohl@gmail.com.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Strohl B A
authors.affiliation: Nara Medical University, Department of Pulmonary Medicine, Nara, Japan. Electronic address: mountain@pastel.ocn.ne.jp.
authors.forename: Motoo
authors.initials: M
authors.lastname: Yamauchi M D
mesh_terms: D006801:Humans; D007002:Hypoglossal Nerve / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
keywords: Genioglossus; Hypoglossal nerve; Neurotherapeutics; Pharynx; Sleep apnea