Abstract
Background
Selective upper airway stimulation of the hypoglossal nerve is a novel therapy option for obstructive sleep apnea. Different tongue motions were observed after surgery during active therapy.
Methods
We examined tongue motions in 14 patients (mean age 51 ± 10 years) who received an implantation of an upper airway stimulation system (Inspire Medical Systems) from September 2013 to February 2014 in three different implantation centers in Germany after surgery. Sleep recording was performed preoperatively: 2 months (M02) and 6 months (M06) after surgery.
Results
There were three different tongue motions observed after surgery at 1 month (M01), M02, and M06 after surgery: bilateral protrusion (BP), right protrusion (RP), and mixed activation (MA). At M01: 10 BP, 2 RP, and 2 MA; at M02: 12 BP, 0 RP, and 2 MA; and at M06: 12 BP, 0 RP, and 2 MA could be detected. The average apnea-hypopnea index (AHI) was reduced from 32.5 ± 14.2/h before surgery to 17.9 ± 23.3/h at M02 and 14.1 ± 19.8/h at M06. An increased reduction in AHI was found in BP and RP group (Baseline: 29.6 ± 12.6/h; M02: 12.06 ± 14.1/h; M06: 9.7 ± 12.6/h) compared to the MA group (Baseline 49.6 ± 13.8/h; M02: 49.7 ± 5.1/h; M06: 40.5 ± 4.1/h).
Conclusions
These findings suggest that the postoperative tongue motions in upper airway stimulation are associated with the therapy outcome. The stimulation electrode placement on the hypoglossal nerve for selective muscle recruitment may play a role in the mechanism of action.
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References
Steier J, Martin A, Harris J, Jarrold I, Pugh D, Williams A (2014) Predicted relative prevalence estimates for obstructive sleep apnoea and the associated healthcare provision across the UK. Thorax 69(4):390–392
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235
Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90(1):47–112
Narkiewicz K, Somers VK (1999) Obstructive sleep apnea as a cause of neurogenic hypertension. Curr Hypertens Rep 1(3):268–273
Martinez D, Klein C, Rahmeier L, da Silva RP, Fiori CZ, Cassol CM, Goncalves SC, Bos AJ (2012) Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors. Sleep Breath; 16(3):695–701
Levy P, Bonsignore MR, Eckel J (2009) Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J; 34(1):243–260
Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165(5):677–682
Palomaki H, Partinen M, Juvela S, Kaste M (1989) Snoring as a risk factor for sleep-related brain infarction. Stroke J Cereb Circul 20(10):1311–1315
Barbe F, Duran-Cantolla J, Capote F, de la Pena M, Chiner E, Masa JF, Gonzalez M, Marin JM, Garcia-Rio F, de Atauri JD, Teran J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM, Spanish S, Breathing G (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726
Catcheside P. G. (2010) Predictors of continuous positive airway pressure adherence. F1000 medicine reports; 2
Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH (2008) Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 178(2):197–202
Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD (2010) Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 33(10):1396–1407
Stuck BA, Dreher A, Heiser C, Herzog M, Kuhnel T, Maurer JT, Pistner H, Sitter H, Steffen A, Verse T (2015) Diagnosis and treatment of snoring in adults-S2k Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery. Sleep Breath; 19(1):135–148
Heiser C, Zimmermann I, Sommer JU, Hormann K, Herr RM, Stuck BA (2013) Pharyngeal chemosensitivity in patients with obstructive sleep apnea and healthy subjects. Chem Senses 38(7):595–603
Miki H, Hida W, Chonan T, Kikuchi Y, Takishima T (1989) Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea. Am Rev Respir Dis; 140(5):1285–1289
Edmonds LC, Daniels BK, Stanson AW, Sheedy 3rd PF, Shepard Jr. JW (1992) The effects of transcutaneous electrical stimulation during wakefulness and sleep in patients with obstructive sleep apnea. Am Rev Respir Dis; 146(4):1030–1036
Decker MJ, Haaga J, Arnold JL, Atzberger D, Strohl KP (1993) Functional electrical stimulation and respiration during sleep. J Appl Physiol (1985); 75(3):1053–1061
Guilleminault C, Powell N, Bowman B, Stoohs R (1995) The effect of electrical stimulation on obstructive sleep apnea syndrome. Chest 107(1):67–73
Eisele DW, Smith PL, Alam DS, Schwartz AR (1997) Direct hypoglossal nerve stimulation in obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 123(1):57–61
Oliven A, Schnall RP, Pillar G, Gavriely N, Odeh M (2001) Sublingual electrical stimulation of the tongue during wakefulness and sleep. Respir Physiol 127(2–3):217–226
Schwartz AR, Eisele DW, Hari A, Testerman R, Erickson D, Smith PL (1996) Electrical stimulation of the lingual musculature in obstructive sleep apnea. J Appl Physiol (1985); 81(2):643–652
1996) Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway. Report of the American Sleep Disorders Association. Sleep 19(2):152–155
Schwartz AR, Barnes M, Hillman D, Malhotra A, Kezirian E, Smith PL, Hoegh T, Parrish D, Eastwood PR (2012) Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea. Am J Respir Crit Care Med 185(4):420–426
Eastwood PR, Barnes M, Walsh JH, Maddison KJ, Hee G, Schwartz AR, Smith PL, Malhotra A, McEvoy RD, Wheatley JR, O'Donoghue FJ, Rochford PD, Churchward T, Campbell MC, Palme CE, Robinson S, Goding GS, Eckert DJ, Jordan AS, Catcheside PG, Tyler L, Antic NA, Worsnop CJ, Kezirian EJ, Hillman DR (2011) Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 34(11):1479–1486
Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, Hohenhorst W, Knaack L, Lin HS, Maurer JT, Netzer A, Odland RM, Oliven A, Strohl KP, Vanderveken OM, Verbraecken J, Woodson BT (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122(7):1626–1633
Maurer JT, Van de Heyning PV, Lin HS, Baskin J, Anders C, Hohenhorst W, Woodson BT (2012) Operative technique of upper airway stimulation: an implantable treatment of obstructive sleep apnea. Oper Tech Otolaryngol Head Neck Surg; 2012(23):227–233
Mu L, Sanders I (2010) Human tongue neuroanatomy: nerve supply and motor endplates. Clin Anat 23(7):777–791
Sanders I, Mu L (2013) A three-dimensional atlas of human tongue muscles. Anat Rec 296(7):1102–1114
Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9(5):433–438
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M. (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the american academy of sleep medicine. J Clin Sleep Med 8(5):597–619
Iber C, Ancoli-Israel S, Chessonn A, Quan SF (2007) In the AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Journal (Issue)
Strollo Jr. PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, Van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP, Group ST (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370(2):139–149
Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep 30(4):461–467
Kezirian EJ, Goldberg AN (2006) Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. Arch Otolaryngol Head Neck Surg 132(2):206–213
Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, Jalbert F, Paoli JR, Sanner B, Smith I, Stuck BA, Lacassagne L, Marklund M, Maurer JT, Pepin JL, Valipour A, Verse T, Fietze I, European Respiratory Society task force on non C. t. i. s. a. (2011) Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 37(5):1000–1028
Woodson BT, Gillespie MB, Soose RJ, Maurer JT, de Vries N, Steward DL, Baskin JZ, Padhya TA, Lin HS, Mickelson S, Badr SM, Strohl KP, Strollo Jr. PJ, Investigators ST, Investigators ST (2014) Randomized controlled withdrawal study of upper airway stimulation on OSA: short- and long-term effect. Otolaryngol Head Neck Surg 151(5):880–887
Mortimore IL, Douglas NJ (1997) Palatal muscle EMG response to negative pressure in awake sleep apneic and control subjects. Am J Respir Crit Care Med 156(3 Pt 1):867–873
Van de Graaff WB, Gottfried SB, Mitra J, van Lunteren E, Cherniack NS, Strohl KP (1984) Respiratory function of hyoid muscles and hyoid arch. J Appl Physiol Respir Environ Exerc Physiol 57(1):197–204
Safiruddin F, Vanderveken OM, de Vries N, Maurer JT, Lee K, Ni Q, Strohl KP (2015) Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions. Eur Respir J; 45(1):129–138
Dotan Y, Golibroda T, Oliven R, Netzer A, Gaitini L, Toubi A, Oliven A (2011) Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea. Eur Respir J; 38(2):338–347
Oliven A, Tov N, Geitini L, Steinfeld U, Oliven R, Schwartz AR, Odeh M (2007) Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J; 30(4):748–758
Conflict of interest
Heiser, C. is the study investigator and consultant of Inspire Medical Systems and received personal fees from Neuwirth, Heinen & Loewenstein, Sutter Medizintechnik outside the submitted work. Maurer, JT. is the study investigator and consultant of Inspire Medical Systems and received personal fees from GlaxoSmithKline, Weinmann, Olympus, ResMed, Neuwirth, Medtronic, and Heinen & Loewenstein and ReVent outside the submitted work. Steffen, A. is the study investigator of Inspire Medical Systems and received honorarium for invited talks from Resmed outside the submitted work.
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Heiser, C., Maurer, J.T. & Steffen, A. Functional outcome of tongue motions with selective hypoglossal nerve stimulation in patients with obstructive sleep apnea. Sleep Breath 20, 553–560 (2016). https://doi.org/10.1007/s11325-015-1237-4
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DOI: https://doi.org/10.1007/s11325-015-1237-4