AASM Membership Sections Newsletter Issue #2
20
American Academy
of Sleep Medicine
(
Schwartz 2012) but power demands would need to
be balanced against device longevity. Stimulation of
the multiple muscles of the lingual hydrostat may
be important for optimal therapy and the optimal
programming of the appropriate combination of
ImThera’s six electrode contacts may need to be elu-
cidated. Alternatively, for Apnex and Inspire Medi-
cal’s devices, selective stimulation of the longitudinal
fibers of the genioglossus muscle could be considered
as it was shown to result in improved airway patency
(
Dotan 2011). Bilateral HGN stimulation could be
considered, especially to treat patients with a very se-
verely elevated AHI or in patients with greater degree
of obesity. If concentric collapse at the level of the soft
palate lowers the likelihood of tongue neurostimula-
tion therapy, one may consider performance of pala-
topharyngoplasty procedure prior to implantation.
Implantable HGN stimulation for OSA is excit-
ing as it may become a new therapeutic modal-
ity for CPAP intolerant patients. It offers patients
a convenient method of nightly therapy and the
potential for neuromuscular training with stimula-
tion may further improve compliance. Optimiza-
tion of stimulation and patient selection will need
further study but in the process we will enhance
our understanding of OSA pathophysiology, tongue
function and neuromodulation. Hypoglossal neuro-
stimulation therapy may also foster collabora-
tions between sleep medicine physicians, surgeons,
neurologists, and scientists.
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Neurostimulation for OSA continued