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Hypoglossal nerve stimulation

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https://www.readbyqxmd.com/read/29280488/tongue-motion-variability-with-changes-of-upper-airway-stimulation-electrode-configuration-and-effects-on-treatment-outcomes
#1
Armin Steffen, Ayse Kilic, Inke R König, Maria V Suurna, Benedikt Hofauer, Clemens Heiser
OBJECTIVES/HYPOTHESIS: Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA). Previous data have demonstrated a correlation between the phenotype of tongue motion and therapy response. Closed loop hypoglossal nerve stimulation implant offers five different electrode configuration settings which may result in different tongue motion. STUDY DESIGN: Two-center, prospective consecutive trial in a university hospital setting. METHODS: Clinical outcomes of 35 patients were analyzed after at least 12 months of device use...
December 27, 2017: Laryngoscope
https://www.readbyqxmd.com/read/29277289/voice-and-swallowing-outcomes-following-hypoglossal-nerve-stimulation-for-obstructive-sleep-apnea
#2
Andrew J Bowen, Amy S Nowacki, Alan H Kominsky, Douglas K Trask, Michael S Benninger, Paul C Bryson
OBJECTIVE: Hypoglossal nerve stimulation is an effective treatment for a subset of patients with Obstructive Sleep Apnea (OSA). Although multiple clinical trials demonstrate its efficacy, no previous literature explores the potential impact the stimulator has on swallowing and voice. Our primary objective is to evaluate patient reported post-operative changes in voice or swallowing following hypoglossal nerve stimulator placement. STUDY DESIGN: Prospective cohort study...
December 15, 2017: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/29276665/insights-since-fda-approval-of-hypoglossal-nerve-stimulation-for-the-treatment-of-obstructive-sleep-apnea
#3
Madeleine M Strohl, Motoo Yamauchi, Zhe Peng, Kingman P Strohl
Purpose: The literature on hypoglossal nerve stimulation (HNS) for the treatment of moderate-to-severe obstructive sleep apnea (OSA) was reviewed from 2014, the time of FDA approval for the Inspire Systems device, to 2017 for themes that might be useful conceptually and practically in the consideration of this new non-anatomic surgical therapy. Recent Findings: there are now further follow-up articles since the 12-month results for Apnea Reduction (STAR) trial of the Inspire device, and post-approval publications which report similar and/0r improved AHI outcomes...
September 2017: Current Sleep Medicine Reports
https://www.readbyqxmd.com/read/29214634/a-case-of-hypoglossal-nerve-stimulator-resistant-obstructive-sleep-apnea-cured-with-the-addition-of-a-chin-strap
#4
Apoorva T Ramaswamy, Carol Li, Maria V Suurna
A population of appropriately selected patients does not respond, or does not achieve cure, with hypoglossal nerve stimulation (HGNS). We describe the case of nonresponder whose obstructive sleep apnea (OSA) resolved with the addition of chin strap. After initial placement and titration of HGNS implant, follow-up sleep study demonstrated persistent moderate OSA. Drug-induced sleep endoscopy demonstrated supraglottic collapse with activate neurostimulation. With mouth closure and change of stimulation settings to unipolar from bipolar, the airway collapse and desaturations improved...
December 7, 2017: Laryngoscope
https://www.readbyqxmd.com/read/29206695/drug-induced-sleep-endoscopy-from-obscure-technique-to-diagnostic-tool-for-assessment-of-obstructive-sleep-apnea-for-surgical-interventions
#5
Joshua H Atkins, Jeff E Mandel
PURPOSE OF REVIEW: Provide a practical update on drug-induced sleep endoscopy (DISE) for anesthesia providers, which can also serve as a reference for those preparing to establish a DISE program. RECENT FINDINGS: New developments in surgical approaches to OSA and the growing global incidence of the condition have stimulated increased interest and demand for drug-induced sleep endoscopy. New techniques include transoral robotic surgery and hypoglossal nerve stimulation...
December 4, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29204583/osa-treatment-history-in-an-upper-airway-stimulation-trial-cohort
#6
Ryan J Soose, Tapan A Padhya, M Boyd Gillespie, Oleg Froymovich, Ho-Sheng Lin, B Tucker Woodson
Objectives: Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial. Methods: Moderate-severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial. Self-reported history on prior OSA medical therapy was collected at enrollment, including OSA diagnosis date, CPAP start and stop dates, oral appliance trial, and reasons for discontinuation or non-adherence...
June 2017: World journal of otorhinolaryngology—head and neck surgery
https://www.readbyqxmd.com/read/29153261/improving-surgical-results-in-complex-nerve-anatomy-during-implantation-of-selective-upper-airway-stimulation
#7
Zhaojun Zhu, Benedikt Hofauer, Clemens Heiser
The following report presents a case of two late embedded hypoglossus branches during implantation of an upper airway stimulation device that caused a mixed activation of the tongue when included in the stimulation cuff. In the end, correct cuff placement could be achieved by careful examination of the hypoglossal nerve anatomy, precise nerve dissection, tongue motion analysis and intraoperative nerve monitoring.
November 15, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/29098288/hypoglossal-nerve-stimulation-in-adolescents-with-down-syndrome-and-obstructive-sleep-apnea
#8
Gillian R Diercks, Carissa Wentland, Donald Keamy, Thomas Bernard Kinane, Brian Skotko, Vanessa de Guzman, Ellen Grealish, John Dobrowski, Ryan Soose, Christopher J Hartnick
Importance: Obstructive sleep apnea (OSA) affects up to 60% of children with Down syndrome (DS) and may persist in half of patients after adenotonsillectomy. Children with DS who have persistent OSA often do not tolerate treatment with positive pressure airway support devices or tracheotomy for their residual moderate to severe OSA. The hypoglossal nerve stimulator is an implantable device that delivers an electrical impulse to anterior branches of the hypoglossal nerve in response to respiratory variation, resulting in tongue base protrusion that alleviates upper airway obstruction in adults...
November 2, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/29050104/-hypoglossal-nerve-stimulation-therapy-for-obstructive-sleep-apnea-hypopnea-syndrome
#9
Q Yan, B Guan
Obstructive sleep apnea hypopnea syndrome(OSAHS) is a clinical and critical disease to health, which the accuratly pathogenesis is not very explicit. The mainstream research suggested that dysfunction of upper airway dilator muscles is one of the hazard factors. Genioglossus innervated by the hypoglossal nerve plays crucial roles. It could expand volume of pharyngeal cavity, and increase airflow rate when stimulate it.With the development of anatomy and physiology, hypoglossal nerve stimulation(HGNS) entered into clinical trials, and had made tremendous progress since 2001...
October 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/29018786/hypoglossal-nerve-stimulation-for-treatment-of-obstructive-sleep-apnea-osa-a-primer-for-oral-and-maxillofacial-surgeons
#10
REVIEW
Sung Ok Hong, Yu-Feng Chen, Junho Jung, Yong-Dae Kwon, Stanley Yung Chuan Liu
The prevalence of obstructive sleep apnea (OSA) is estimated to be 1-5% of the adult population world-wide, and in Korea, it is reported at 4.5% of men and 3.2% of women (Age 40 to 69 years old). Active treatment of OSA is associated with decrease in insulin resistance, cardiovascular disease, psychosocial problems, and mortality. Surgical treatment of OSA has evolved in the era of neuromodulation with the advent of hypoglossal nerve stimulation (HGNS). We share this review of HGNS with our maxillofacial surgical colleagues to expand the scope of surgical care for OSA...
December 2017: Maxillofacial Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28983236/development-of-a-clinical-pathway-and-technical-aspects-of-upper-airway-stimulation-therapy-for-obstructive-sleep-apnea
#11
REVIEW
Olivier M Vanderveken, Jolien Beyers, Sara Op de Beeck, Marijke Dieltjens, Marc Willemen, Johan A Verbraecken, Wilfried A De Backer, Paul H Van de Heyning
Obstructive sleep apnea (OSA) is a common disease with high morbidity and related mortality. Narrowing and collapse of the pharyngeal airway during sleep characterize the disease, resulting in a decrease (hypopnea) or a complete cessation (apnea) of oronasal airflow. Upper airway stimulation (UAS), using electrical neurostimulation of the hypoglossal nerve (n. XII) synchronized with ventilation, is a novel, evolving treatment option. UAS was found to be an effective treatment in CPAP-intolerant patients. The treatment success is partly due to the strict selection of the patients, based on previous findings...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28960569/surgical-anatomy-of-the-hypoglossal-nerve-a-new-classification-system-for-selective-upper-airway-stimulation
#12
Clemens Heiser, Andreas Knopf, Benedikt Hofauer
BACKGROUND: Selective upper airway stimulation (UAS) has shown effectiveness in treating patients with obstructive sleep apnea (OSA). The terminating branches of the hypoglossal nerve show a wide complexity, requiring careful discernment of a functional breakpoint between branches for inclusion and exclusion from the stimulation cuff electrode. The purpose of this study was to describe and categorize the topographic phenotypes of these branches. METHODS: Thirty patients who received an implant with selective UAS from July 2015 to June 2016 were included...
December 2017: Head & Neck
https://www.readbyqxmd.com/read/28923761/surgical-treatment-of-osa-on-cardiovascular-outcomes-a-systematic-review
#13
Tyler R Halle, Melissa S Oh, Nancy A Collop, Arshed A Quyyumi, Donald L Bliwise, Raj C Dedhia
BACKGROUND: OSA is an increasingly prevalent clinical problem with significant effects on quality of life and cardiovascular risk. Surgical therapy represents an important treatment for those unable to use positive airway pressure. This systematic review examines the available cardiovascular risk reduction data for the surgical treatment of OSA. METHODS: A comprehensive literature search was performed. Articles were included if they met the following criteria: (1) the sample population consisted of adults (age ≥ 18 years); (2) OSA was diagnosed according to a sleep study; (3) surgical intervention was performed for OSA; and (4) one or more physical or biochemical cardiovascular and/or cerebrovascular variables was measured preoperatively and at ≥ 14 days postoperatively...
September 18, 2017: Chest
https://www.readbyqxmd.com/read/28901030/treating-osa-current-and-emerging-therapies-beyond-cpap
#14
REVIEW
Geraldo Lorenzi-Filho, Fernanda R Almeida, Patrick J Strollo
Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence...
November 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28777178/sleep-disordered-breathing
#15
Nancy R Foldvary-Schaefer, Tina E Waters
PURPOSE OF REVIEW: Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as sleep-related hypoventilation and hypoxemia. Diagnostic criteria have been updated in the International Classification of Sleep Disorders, Third Edition and the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events. Neurologic providers should have basic knowledge and skills to identify at-risk patients, as these disorders are associated with substantial morbidity, the treatment of which is largely reversible...
August 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28771734/modified-surgical-approach-to-hypoglossal-nerve-stimulator-implantation-in-the-pediatric-population
#16
Sarah N Bowe, Gillian R Diercks, Christopher J Hartnick
Upper airway stimulation with the hypoglossal nerve stimulator is a promising treatment modality for severe obstructive sleep apnea in carefully selected patients with Down syndrome. The pediatric population presents a greater variety in body habitus, including thorax size. A modified surgical approach, utilizing a medially placed, single chest incision, instead of two separate chest incisions, provides an alternative that is particularly useful for pediatric patients with small stature. As this technology is evaluated for Food and Drug Administration clearance in the pediatric population, it is important to consider modifications in surgical technique, partnering prior surgical experience with the technical support of company representatives...
August 3, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28755767/hypoglossal-nerve-stimulation-surgery-for-obstructive-sleep-apnoea-our-preliminary-experience
#17
Peter Baptista, Octavio Garaycochea, Laura Álvarez-Gómez, Juan Alcalde, Manuel Alegre, Elena Urrestarazu
The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O2 Sat, average O2 Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference...
July 26, 2017: Acta Otorrinolaringológica Española
https://www.readbyqxmd.com/read/28738358/innovative-surgery-for-obstructive-sleep-apnea-nerve-stimulator
#18
REVIEW
J Ulrich Sommer, Karl Hörmann
Obstructive sleep apnea (OSA) as a multifactorial disease is treated with continuous positive airway pressure (CPAP) as the gold standard. Yet, if patients suffer from CPAP incompliance, traditional OSA surgery only targets morphological changes of the upper airway while neglecting functional issues. With the advent of upper airway stimulation, and in particular hypoglossal nerve stimulation as a treatment option, a highly effective, clinically proven and functional therapy with good evidence is available. This article gives a comprehensive overview of current and upcoming hypoglossal nerve stimulation systems (Inspire, ImThera, and Nyxoah), the specific advantages of this approach, the selection criteria and screening process, relevant clinical data, and a description of the different implantation procedures...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28730908/electrical-stimulation-for-the-treatment-of-obstructive-sleep-apnoea-a-review-of-the-evidence
#19
Valeria Bisogni, Martino F Pengo, Andrea De Vito, Giuseppe Maiolino, Gian Paolo Rossi, John Moxham, Joerg Steier
Obstructive sleep apnoea is an increasingly prevalent clinical condition with significant impact on individuals and public health. Continuous positive airway pressure therapy is the standard treatment, but adherence is limited and alternative treatments are needed. In this context, non-invasive and invasive methods for the electrical stimulation of upper airway dilator muscles have been demonstrated to be effective in selected patients. Areas covered: This review will cover investigations on the clinical effects, safety, and tolerability of non-invasive and invasive electrical stimulation of the upper airway for the management of obstructive sleep apnoea...
September 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28715374/in-vivo-evaluation-of-the-mechanical-and-viscoelastic-properties-of-the-rat-tongue
#20
Emanuele Loro, Stephen H Wang, Richard J Schwab, Tejvir S Khurana
The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include supporting mastication and deglutition, as well as taste-sensing and phonetics. Accordingly, the strength and volume of the tongue can impact the ability of vertebrates to accomplish basic activities such as feeding, communicating, and breathing. Human patients with sleep apnea have enlarged tongues, characterized by reduced muscle tone and increased intramuscular fat that can be visualized and quantified by magnetic resonance imaging (MRI)...
July 6, 2017: Journal of Visualized Experiments: JoVE
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