Hypoglossal Nerve Stimulator

Abstract Introduction Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients. Methods Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings. Results Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE. Conclusion In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study. Support Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)

Download Full-text

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2018.4077 ◽

2019 ◽

Vol 145 (4) ◽

pp. 389 ◽

Cited By ~ 2

Author(s):

Kathleen M. Sarber ◽

Stacey L. Ishman ◽

Reena Dhanda Patil

Keyword(s):

Sleep Apnea ◽

Hypoglossal Nerve ◽

Nerve Stimulator ◽

Cheyne Stokes Breathing

Download Full-text

0862 POLYSOMNOGRAPHIC CHARACTERISICS OF PEDIATRIC DOWNS SYNDROME PATIENTS BEFORE AND AFTER HYPOGLOSSAL NERVE STIMULATOR IMPANT

SLEEP ◽

10.1093/sleepj/zsx050.861 ◽

2017 ◽

Vol 40 (suppl_1) ◽

pp. A320-A320

Author(s):

D Keamy ◽

G Dierks ◽

C Hartnick ◽

B Kinane

Keyword(s):

Hypoglossal Nerve ◽

Nerve Stimulator ◽

Downs Syndrome ◽

Before And After

Download Full-text

Cricopharyngeal Muscle Dysfunction Following Hypoglossal Nerve Stimulator Placement

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2018.1700 ◽

2018 ◽

Vol 144 (10) ◽

pp. 948

Author(s):

Bryan J. Stevens ◽

Ashley M. Geer ◽

Gregory R. Dion ◽

Adrienne M. Laury ◽

Nicholas J. Scalzitti

Keyword(s):

Hypoglossal Nerve ◽

Muscle Dysfunction ◽

Nerve Stimulator ◽

Cricopharyngeal Muscle

Download Full-text

0645 The Association of Hypoglossal Nerve Stimulator Adherence and Insomnia

SLEEP ◽

10.1093/sleep/zsaa056.641 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A246-A246

Author(s):

M Sharma ◽

A Chacko ◽

M Rosenthal ◽

M Khan

Keyword(s):

Hypoglossal Nerve ◽

Sleep Problems ◽

Medical Center ◽

Eligible Patient ◽

Upper Airway ◽

Severity Index ◽

Nerve Stimulator ◽

Obstructive Sleep ◽

Significant Difference ◽

The Ohio State University

Abstract Introduction The gold standard for treatment of Obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, CPAP adherence is less than 50%. An alternative treatment is the hypoglossal nerve stimulator (HNS) which displaces the tongue anteriorly to treat upper airway obstruction. Difficulties tolerating HNS are related to stimulation discomfort. In this study, we investigated insomnia as a barrier to adherence. Methods Patients implanted and activated with HNS at The Ohio State University Wexner Medical Center between 2015 and 2019 were eligible. Patient usage data from the previous six months was obtained and subjects were asked to complete an Insomnia Severity Index (ISI). Participants were divided into adherent (defined as use ≥28 hours/week) and non-adherent (use <28 hours/week). Results 32 subjects were enrolled, 22 in the adherent group and 10 in the non-adherent group. There was a significant decrease in mean treatment AHI in both groups: 36.25 to 11.14 in the adherent group and 36.30 to 15.69 in the non-adherent group (p<0.0001). The mean ISI score in the adherent group was 6.84 which is consistent with no clinically significant insomnia and 8.67 in the non-adherent group consistent with subthreshold insomnia. However, there was not a statistically significant difference between the two groups (p=0.441). There was a statistically significant higher score for the question “Do you worry about your sleep problems?” in the non-adherent group (1.78, SD1.39 vs 0.74. SD 0.81) (p =0.018). Conclusion This study suggests that patients who have difficulty with sleep may have more difficulty with HNS adherence than those who do not. In particular the question stating “Do you worry about your sleep problems” had a statistically higher score in the non-adherent group. Prospective studies are needed to further explore a possible relationship between insomnia and HNS adherence. Support N/A

Download Full-text

1220 A CASE OF HYPOGLOSSAL NERVE STIMULATOR CERVICAL LEAD CUFF DISLODGEMENT

SLEEP ◽

10.1093/sleep/zsaa056.1214 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A466-A466

Author(s):

Hamed Ali ◽

Sowjanya Duthuluru

Keyword(s):

Hypoglossal Nerve ◽

Pulse Generator ◽

Rare Complication ◽

Alternative Therapy ◽

Distal Portion ◽

Clinic Visit ◽

Nerve Stimulator ◽

Obstructive Sleep ◽

The Right

Abstract Introduction Hypoglossal Nerve Stimulation (HGNS) has become an alternative therapy for moderate to severe obstructive sleep apnea (OSA) patients intolerant to PAP therapy. HGNS devices typically comprise of implantable pulse generator (IPG) placed surgically in an infraclavicular subcutaneous pocket. An electrode cuff attached to the IPG wraps around the distal portion of the of the hypoglossal nerve. This device has an implantable chest sensor that monitors the respiratory efforts. Report of Case A 76-year-old male with history of severe OSA (AHI 39 /hour) was intolerant to PAP therapy. HGNS was implanted in the right infraclavicular pocket under general anesthesia without any complications. Patient had successful tongue motion to stimulus per protocol intra- operatively in the OR. However, no tongue movement was noted despite maximum stimulation up to 4.5 V at follow up clinic visit. Follow up C spine x ray showed very low-lying HGNS cervical lead cuff, and possible dislodgement. Patient was taken back to the OR. Intraoperatively it was noted that the previously placed cervical lead cuff has folded back and was lying on the surface of the submandibular gland /digastric anchor site. It was dissected free and replaced on the distal inclusion branches of the hypoglossal nerve with loupe magnification and EMG confirmation (tongue deviation at 1.5 volts). Patient developed tongue neuropraxia with difficulty swallowing, difficulty speaking and right sided tongue deviation lasting for months, that gradually improved. Patient had successful HNS activation 6 months later using 2.2 V. Conclusion (HGNS) failure secondary to cervical lead cuff dislodgement is a rare complication and should be taken in consideration. Post-operative imaging and comprehensive clinical examination are crucial in detecting such problems. Temporary tongue neuropraxia post Hypoglossal nerve stimulator placement is another possible complication.

Download Full-text