How Hypoglossal Nerve Stimulation Can Help Patients With Obstructive Sleep Apnea

When it comes to treating obstructive sleep apnea (OSA), positive airway pressure therapies, like CPAP or BiPAP, are the first-line treatment option. Many patients cannot tolerate these therapies, however, leaving health care professionals and lay people alike wondering if there might be a better option. 

In this video, Jaspal Singh, MD, MHA, MHS, Pulmonary Oncology and Critical Care Education medical director at Atrium Health Levine Cancer Institute, Charlotte, North Carolina, discusses hypoglossal nerve stimulation, a novel treatment for OSA. Dr Singh explains how this cutting-edge technology provides a lifeline for individuals unable to tolerate traditional CPAP therapy, promising a restful night's sleep and improved quality of life.

Read the Transcript:

Pulmonology Learning Network: Can you give a brief explanation of hypoglossal nerve stimulation and how it is being used to treat patients with obstructive sleep apnea?

Jaspal Singh, MD, MHA, MHS: I've treated obstructive sleep apnea for a long time with traditional therapies, whether that be through non-positive airway pressure therapies, but also positive airway pressure therapies like CPAP or BiPAP. A fair number of our patients over time, however, for various reasons, cannot tolerate CPAP therapy. So, people have been looking at new ideas for how to manage their sleep disorder and breathing with other devices.

One of the things that came up was hypoglossal nerve stimulation. Initially I was very much a skeptic of this therapy, but sure enough, there are some patients that really benefit from it. This involves a device that actually is implanted with the power mechanism under the chest, that connects to the hypoglossal nerve and stimulates it. The idea is that it creates some tone, and that increased tone opens the airways to provide enough air capacity. Otherwise, in sleep apnea, especially obstructive sleep apnea, the airway in the back of the throat essentially starts to close up, especially when you're in deeper levels of sleep. That interruption of sleep can have a number of sequelae and consequences.

In practice, one would activate the hypoglossal nerve stimulator when you go into sleep. It then creates this sort of tone that helps keep the airway open so that patients can effectively breathe, despite the potential for closure. This  approach is oftentimes preferred for some patients who aren't able to use CPAP therapy. Now, to be fair, CPAP therapy is still the frontline, recommended therapy, especially for moderate to severe obstructed sleep apnea. For the few patients that don't do well with CPAP therapy, we do oftentimes put them through evaluation whether they're a candidate for hypoglossal nerve stimulation. 

PLN: Can you elaborate on the endoscopy, surgery, and recovery for implanting a hypoglossal nerve stimulator? 

Dr Singh: I'm not a surgeon--I'm actually going to go see my first case in person next week. I've sent patients for the procedure, but I don't actually do it myself. So I would best talk with a surgeon who does a fair number of these. So I'm very particular about this.

Basically the patient would come in in the morning, they would be intubated, and then they're positioned on their back to assess the hypoglossal nerve activity by using what's called an EMG to assess how that responds. Then, they place a stimulation lead in the neck crease, just underneath the mandible. After that, they insert what's called the sensor, the respiratory sensor lead, which is on the anterior chest wall, kind of just below the clavicle. Finally, they go through and they interrogate the system before they close it.

The surgical patient heals for several weeks. During follow-up, medical professionals look to make sure everything is going well, and assess the patient for side effects from the procedure. Once the patient's healed, they start calibrating the system, and adjust it over time to make sure that it's working correctly and the device is actually activated at home with the remote. Essentially, there's a sensor that the patients themselves have control over when they're sleeping, they activate it and people have already seen the commercials already. 

Jaspal Singh, MD, MHA, MHS, is board-certified in internal medicine, pulmonary disease, sleep medicine, and critical care medicine. He specializes in treating lung nodules, lung cancer, pleural effusions, obstructive sleep apnea and mechanical ventilation. He is the medical director for Innovation and Quality Improvement for Pulmonary Oncology at Atrium Health Levine Cancer Institute and the medical director for Critical Care Practice and Education at the Jan & Ed Brown Center for Pulmonary Medicine. He received his medical degree at the University of Illinois. He completed residency at the University of Rochester (Strong Memorial Hospital), and fellowship training at Duke University Medical Center.