Airway Evaluation in Response to Hypoglossal Nerve Stimulation: A Case Report (original) (raw)

2017, Journal of Dental Sleep Medicine

JDSM Study Objectives: Upper airway stimulation (UAS) using a unilateral implantable neurostimulator for the hypoglossal nerve is a relatively novel option for patients with obstructive sleep apnea (OSA). This may be especially useful to patients who cannot tolerate continuous positive airway pressure (CPAP) or oral appliance therapy. The aim of this study is to describe the use of relatively new technology in treatment of OSA using a fully implanted system by stimulating the hypoglossal nerve, and to evaluate pharyngeal changes in a patient with an implanted UAS system. Methods: A 61-y-old man with a diagnosis of severe OSA, apnea-hypopnea index (AHI) of 37 events/h, lowest oxygen saturation of 85%, and claustrophobia who could not tolerate CPAP therapy underwent t he following procedures at different times, two uvulopalatopharyngoplasties, two nasal septum procedures, maxillary-mandibular advancement, genioglossus advancement surgeries, and insertion of oral appliances, decreasing the AHI to 28 events/h (moderate). A more permanent solution was desired. The UAS system was implanted, and soon afterward, three lateral cephalograms were taken at different degrees of stimulation: no stimulation (T1), low voltage (T2), and high voltage (T3). Results: UAS led to a decrease in the AHI to 8.5 (mild), with an acceptable oxygen saturation of 90%, with the patient reporting significant improvement in quality of life. With stimulation, the upper pharyngeal width increased from 6.5 mm (T1) to 7.1 mm (T2) and 8.3 mm (T3). The lower pharyngeal width increased from 5.5 mm (T1) to 8.5 mm (T2), and 9.5 mm (T3). Conclusion: Implantable UAS may be considered in patients with OSA who have difficulties with CPAP therapy.