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Sonographic evaluation of tongue motions during upper airway stimulation for obstructive sleep apnea—a pilot study

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Introduction

The objective was to evaluate the feasibility of sonographic evaluation of functional tongue motion as a tool to evaluate postoperative outcomes in human subjects using breathing-synchronized stimulation of the hypoglossal nerve—a novel therapy option for patients with obstructive sleep apnea (OSA).

Material and methods

Sixteen patients with OSA (n = 16, age 60.4 ± 10.2, BMI 28.7 ± 2.4, AHI 35.0 ± 11.8) underwent sonographic evaluation of tongue motion after initiation of therapy with the Inspire II Upper Airway Stimulation system. Sonographic examination was performed in four different planes (A = floor of the mouth frontal, B = base of the tongue horizontal, C = floor of the mouth parallel to mandible, and D = floor of the mouth median sagittal) in an attempt to visualize tongue surface, tongue and hyoid motion, and the distance of protrusion.

Results

Identification of the tongue surface was achieved in all cases in planes B, C, and D and 81 % of patients in plane A. Tongue motion was evident on the right (implant) side in 63 % in plane A and 75 % in plane B. Distance of protrusion was measured in plane B at 1.04 cm (±0.51), in plane C at 1.08 cm (±0.47), and in plane D at 0.96 cm (±0.45). Hyoid protrusion was measured in plane C or D and was 0.57 cm (±0.39). Significant correlations among the three planes were observed, but there was no correlation to the reduction of apnea-hypopnea index.

Conclusion

The results indicate feasibility of sonography to identify tongue and hyoid motions during upper airway stimulation. Useful sonographic planes and landmarks, which allow visualization of dynamic effects of upper airway stimulation, could be established. The evaluation of the tongue in a horizontal (B) and in a sagittal plane (D) appears to be superior to the other investigated planes. The approximate tongue protrusion needed to generate a significant reduction of AHI and ODI was 1 cm.

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Authors and Affiliations

  1. Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany

    Benedikt Hofauer, Andreas Knopf, Murat Bas, Markus Wirth & Clemens Heiser

  2. Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center and Case Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Kingman Strohl

  3. Nephrology/II. Medical Department, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Konrad Stock

Authors
  1. Benedikt Hofauer
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  2. Kingman Strohl
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  3. Andreas Knopf
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  4. Murat Bas
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  5. Markus Wirth
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  6. Konrad Stock
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  7. Clemens Heiser
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Corresponding author

Correspondence to Benedikt Hofauer.

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Funding

No funding was received for this research.

Conflict of interest

Benedikt Hofauer, Andreas Knopf, Muras Bas, Markus Wirth, and Konrad Stock certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript. Kingman Strohl is the Site Principal Investigator at Case Medical Center for the Star Phase III FDA trial and for the Post-Approval Study for upper airway stimulation (Inspire Medical Systems); no other conflicts to declare. Clemens Heiser is study investigator and consultant of Inspire Medical Systems and received personal fees from Neuwirth Medical Products, Heinen & Loewenstein, Sutter Medizintechnik, outside the submitted work; no other conflicts to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments of comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hofauer, B., Strohl, K., Knopf, A. et al. Sonographic evaluation of tongue motions during upper airway stimulation for obstructive sleep apnea—a pilot study. Sleep Breath 21, 101–107 (2017). https://doi.org/10.1007/s11325-016-1383-3

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  • DOI: https://doi.org/10.1007/s11325-016-1383-3

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