gms | German Medical Science

Objective: To evaluate outcome measures and objective adherence data for patients with moderate to severe obstructive sleep apnea (OSA), treated with inspiration-triggered stimulation of the hypoglossal nerve.

Methods: The first 8 patients who were treated with hypoglossal stimulation therapy at our institution were included in the analysis. In five patients, the polysomnographic titration process has been completed. All patients had moderate to severe OSA and could not adhere to positive pressure therapy. Previously published inclusion criteria were met, including absence of complete concentric collapse at the velopharyngeal level. The analysis included demographics, body mass index (BMI), apnea-hypopnea index (AHI), nightly hours of device usage, as well as procedure- and therapy-related complications.

Results: Mean age for the whole group was 62 years, with 50% female. In the five patients, who completed the polysomnographic titration, the mean AHI decreased significantly under the therapy (34.75 to 2.75; P = 0.015). Four of five patients achieved a treatment AHI < 5, one patient an AHI <10. Average amplitude of stimulation was 1.7 V after polysomnographic titration. Device interrogation showed high rates of device use with a mean of 51 h/night. In one patient, a revision surgery was necessary four weeks after the initial surgery for electrode dislocation.

Conclusion: For a defined clinical and anatomical subset of patients with moderate to severe OSA, hypoglossal stimulation provides an alternative after failed first-line therapy (CPAP). The stimulation significantly improved OSA burden, improves quality of life and is associated with good objective adherence as well as low perioperative morbidity. The reported results suggest that hypoglossal stimulation therapy can be used successfully in routine clinical practice.