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Electrical stimulation of the whole hypoglossal nerve in patients with obstructive sleep apnea

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dc.contributor.author Oliven, A.
dc.contributor.author Dotan, Y.
dc.contributor.author Golibroda, T.
dc.contributor.author Somri, M.
dc.contributor.author Oliven, R.
dc.contributor.author Schwartz, A.R.
dc.date.accessioned 2020-12-14T16:10:02Z
dc.date.available 2020-12-14T16:10:02Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8752
dc.description.abstract Purpose: Electrical stimulation of the whole hypoglossal nerve (HGp-ES) has been demonstrated to enlarge the pharynx and improve pharyngeal stability and patency to airflow in all animals studied, but not in humans. The present study was undertaken to better understand the effect of HGp-ES on the human pharynx. Methods: Eight patients with obstructive sleep apnea who had implanted stimulators with electrodes positioned proximally on the main truck of the hypoglossus were studied under propofol sedation. Pharyngoscopy and air flow measurements at multiple levels of continuous positive airway pressure (CPAP) were performed before and during Hgp-ES. Results: HGp-ES that activates both tongue protrusors and retractors narrowed the pharyngeal lumen at the site of collapse (velopharynx in all subjects) from 1.38 ± 0.79 to 0.75 ± 0.44 cm2, p < 0.05 (measured at mid-range of CPAP levels) and lowered airflow (from 8.88 ± 2.08 to 6.69 ± 3.51 l/min, p < 0.05). Changes in critical pressure (Pcrit) and velopharyngeal compliance were not significant, but oropharyngeal compliance decreased (from 0.43 ± 0.18 to 0.32 ± 0.13 cm2/cmH2O, p < 0.05). No correlation was found between the pattern of change in luminal shape (determined as the ratio of a–p vs. lateral diameter when lowering CPAP) or changes in cross-sectional area and airflow during Hgp-ES. Conclusions: Our findings indicate that human retractors dominate when stimulated together with the protrusors during HGp-ES. While co-activation of retractors may be beneficial, it should be limited. We speculate that exercises that augment protrusor force may improve the response to hypoglossal stimulation. The exclusion of patients with concentric pharyngeal obstruction should be re-evaluated. en_US
dc.language.iso eng
dc.publisher Springer
dc.relation.ispartofseries Sleep and Breathing
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Hypoglossus en_US
dc.subject Functional electrical stimulation en_US
dc.subject Tongue en_US
dc.subject Sleep apnea en_US
dc.subject Pharyngeal collapse en_US
dc.subject Drug induced sedation endoscopy (DISE) en_US
dc.title Electrical stimulation of the whole hypoglossal nerve in patients with obstructive sleep apnea en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1007/s11325-019-02011-1
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.07
dc.relation.issn 1522-1709


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