Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

Abstract

Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist. The continuous HNS without respiratory sensing does not require a sleep endoscopy for indication. For the bilateral continuous HNS as the single partially implantable device, a feasibility study exists. For indication, the assessment of positive airway pressure failure by sleep medicine is crucial, and the decision for HNS should be made in discussion of other treatment options for at least moderate OSA. The implantation center holds primarily responsibility among the interdisciplinary sleep team and is primary contact for the patient in problems. This depicts why structural processes are required to secure outcome quality and minimize the complications. The aftercare of HNS patients can be provided interdisciplinary and by different medical institutions, whereat, minimal reporting standards to document outcome and usage are recommended.

Dynamics of Circulating CD14/CD16 Monocyte Subsets in Obstructive Sleep Apnea Syndrome Patients upon Hypoglossal Nerve Stimulation

“…Usage time of 4 h per night is considered sufficient for successful therapy in terms of daytime sleepiness and the risk for cardiovascular disease [ 3 , 4 , 5 , 6 ]. Hypoglossal nerve stimulation (HNS) in patients with OSA and CPAP failure has been applied since the 1990s, mainly the STAR trial of 2014 [ 7 ] led to the increased clinical application and intensive scientific interest [ 8 ]. The apnea–hypopnea index (AHI) between 15 and 65/h as well as the exclusion of a complete concentric collapse in a drug-induced sleep endoscopy have to be highlighted as inclusion criteria.…”

Hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea: A systematic review and meta-analysis

“…However, even after surgery or after CPAP use is discontinued, the condition can persist ( 29 ). Previous studies have proven that HNS is an effective treatment option for OSA in adults, particularly for those who cannot tolerate CPAP therapy ( 30 ). According to a single-center study, the mean AHI for patients with OSA who were treated with HNS decreased from 38.9 ± 12.5 to 4.5 ± 4.8, whereas the mean AHI for those who underwent uvulopalatopharyngoplasty surgery decreased from 40.3 ± 12.4 to 28.8 ± 25.4 ( 31 ).…”

Hypoglossus-Stimulation: Indikation, operative Technik und klinische Ergebnisse

“…Gemäß der S3-Leitlinie zu schlafbezogenen Atmungsstörungen sollten die Möglichkeiten einer Lagetherapie bei Rückenlage-bezogener OSA und Anpassung einer Unterkieferprotrusionsschiene bei ausreichendem Vorschub des Unterkiefers und intaktem Zahnstatus vor der Indikationsstellung zur Hypoglossus-Stimulation abgeklärt werden [6]. [7]. Ergebnisse von Kohortenstudien und der internationalen Registerstudie (ADHERE) legen nahe, dass bei den Patienten mit höherem BMI mit einer relevanten Abnahme der Effektivität der Stimulationstherapie zu rechnen ist [6].…”