Therapeutic Strategies
Hypoglossal Nerve Stimulation
Image created by Inspire Medical Systems
Hypoglossal nerve stimulation (HGNS) is an emerging treatment for moderate to severe OSA that involves the electrical stimulation of the hypoglossal nerve to activate the genioglossus muscle and maintain airway patency during sleep.
It involves the surgical implantation of a small device under the skin in the upper chest region. This device consists of a pulse generator, a stimulation lead, and a sensing lead.
Stimulation Lead Placement
The stimulation lead is carefully placed in close proximity to the hypoglossal nerve, which controls the movement of the tongue.
Sensing Lead Placement
The sensing lead is placed between the intercostal muscles to detect the patient's breathing patterns.
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When the device senses a decrease in breathing or an apnoea event, it sends electrical impulses to the hypoglossal nerve, which in turn stimulates the genioglossus muscle, the primary tongue protruder.
This stimulation helps to maintain airway patency during sleep by preventing the tongue from collapsing into the airway and obstructing breathing. The device can be adjusted and programmed by the physician to optimise its effectiveness based on individual patient needs.
Clinical trials have demonstrated HGNS's efficacy in reducing AHI and improving subjective measures of sleep quality and daytime sleepiness.
However, HGNS is an invasive procedure with potential risks and is currently reserved for patients who have failed or are intolerant to CPAP and oral appliance therapy.