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Ansa cervicalis stimulation increases pharyngeal patency in patients with obstructive sleep apnea

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dc.contributor.author Kent, D.T.
dc.contributor.author Scott, W.C.
dc.contributor.author Zealear, D.
dc.contributor.author Schwartz, A.R.
dc.date.accessioned 2021-10-04T23:00:55Z
dc.date.available 2021-10-04T23:00:55Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9782
dc.description.abstract Hypoglossal nerve stimulation (HNS) is an alternative treatment option for obstructive sleep apnea (OSA) that reduces pharyngeal collapsibility, but HNS nonresponders often demonstrate continued retropalatal and lateral pharyngeal wall collapse. Recent evidence suggests that caudal pharyngeal traction with sternothyroid muscle contraction via ansa cervicalis stimulation (ACS) can also stabilize the pharynx, but the underlying mechanisms have not been elucidated. Our objective was to evaluate the effect of ACS on pharyngeal patency during expiration when the airway is most hypotonic. Eight participants with OSA underwent sustained ultrasound-guided fine-wire stimulation of the medial branch of the right hypoglossal nerve with and without transient stimulation of the branch of the ansa cervicalis nerve plexus innervating the right sternothyroid muscle during drug-induced sleep endoscopy. Airway cross-sectional area and expiratory airflow (V-E) were measured from endoscopy video with ImageJ and pneumotachometry, respectively. ACS significantly increased retropalatal cross-sectional area (CSARP) to 211% [159–263] of unstimulated CSARP (P < 0.05). Adding ACS to HNS increased CSARP from baseline by 341% [244–439] (P < 0.05), a 180% [133–227] increase over isolated HNS (P < 0.05). ACS increased V-E from baseline by 177% [138–217] P < 0.05). Adding ACS to HNS increased V- E by 254% [207–301], reflecting decreases in pharyngeal collapsibility. Combining ACS with HNS increased retropalatal cross-sectional area and increased expiratory airflow, suggesting decreases in pharyngeal collapsibility. Our findings suggest that ACS exerts caudal traction on the upper airway through sternothyroid muscle contraction and that it may augment HNS efficacy in patients with OSA. NEW & NOTEWORTHY Ansa cervicalis stimulation (ACS) is a recently proposed neurostimulation mechanism for generating caudal pharyngeal traction that may benefit patients with obstructive sleep apnea. Here, we document endoscopic findings with ACS during drug-induced sleep endoscopy and additionally detail the effects of ACS on expiratory airflow, when the pharynx is known to be most hypotonic en_US
dc.language.iso eng
dc.publisher American Physiological Society
dc.relation.ispartofseries Journal of Applied Physiology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Ansa cervicalis en_US
dc.subject Hypoglossal nerve stimulation en_US
dc.subject Obstructive sleep apnea en_US
dc.subject Respiratory neurostimulation en_US
dc.subject Tracheal traction en_US
dc.title Ansa cervicalis stimulation increases pharyngeal patency in patients with obstructive sleep apnea en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1152/japplphysiol.00076.2021
dc.relation.issn 1522-1601


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