Hypoglossal Nerve Stimulation in Moderate to Severe Obstructive Sleep Apnea – the UKE Experience

Introduction 

Obstructive sleep apnea (OSA) refers tot the recurrent obstruction of the upper airways, especially of the pharynx, while asleep. The therapeutic approach is primarily of conservative nature, i.e. PAP ventilation during nighttime. In the event of non-adherence to PAP-ventilation or failure of conservative therapy, stimulation of the hypoglossal nerve is a guideline-conform alternative. In this study, perioperative and poly-/somnographic results after implantation of a respiration-dependent hypoglossal nerve stimulator are presented.

Methods 

Monocentric, retrospective analysis of all hypoglossal nerve stimulator implantations. Description of the pre- and postoperative procedure as well as the follow-up.

Results 

From July 2018 to September 2021, n = 20 patients were treated with a respiration-dependent, unilateral hypoglossal nerve stimulator (Upper Airway Stimulation, Inspire). The patients with a mean age of 55.7 years and an average pre-obese BMI of 29.9 kg/m² showed a polysomnographic mean AHI of 33.2. Nine respectively 11 patients suffered from moderate or severe OSA, respectively, with pathological daytime sleepiness (ESS median 11/24 points) and PAP non-adherence. After surgical treatment, the AHI decreased by an average of 73% to 7.9. Pre- and postoperative AHI, nocturnal minimal O2 saturation and ESS score showed a significant reduction. The Sher criteria for treatment control were met in 14/15 cases. In only 10% of the cases there were early-onset complications within 30 days after surgery without altering the poly-/somnographic results of the therapy.

Discussion 

With guideline-conform patient selection and correctly performed surgery, excellent polysomnographic and clinical success rates for the therapy of OSA can be achieved.

Publication History

Article published online:
24 May 2022