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Hypoglossal nerve stimulation

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https://www.readbyqxmd.com/read/27858088/specific-branches-of-hypoglossal-nerve-to-genioglossus-muscle-as-a-potential-target-of-selective-neurostimulation-in-obstructive-sleep-apnea-anatomical-and-morphometric-study
#1
Philippe Delaey, Jérôme Duisit, Catherine Behets, Thierry Duprez, Pierre Gianello, Benoît Lengelé
PURPOSE: To determine the ideal implantation site for selective tongue neurostimulation in obstructive sleep apnea, anatomy of the distal branching of the hypoglossal nerve (HGN) was revisited. METHODS: The HGN distal course and intramuscular distribution to the tongue muscles were studied in 17 embalmed and 5 fresh heads (age 60-98, BMI 20-35). Medial branches supplying selectively the genioglossus (GG) muscle were identified. Then, the distinct bundles entering the oblique (GGo) and horizontal (GGh) parts of the GG were located...
November 17, 2016: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/27829262/-upper-airway-stimulation-in-osa
#2
B Bender
Anatomical basis of obstructive sleep apnea (OSA) is the collapse of the pharynx during sleep. It is considered as a result of complex interactions of structural and neuromuscular factors. Depth of sleep and body position have modulating effects. Although different areas of obstruction were identified, studies show that the sleep-mediated obstruction frequently occurs in the base of tongue area.Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea syndrome (OSAS) since more than 30 years...
November 2016: Laryngo- Rhino- Otologie
https://www.readbyqxmd.com/read/27762236/nerve-cuff-electrode-using-embedded-magnets-and-its-application-to-hypoglossal-nerve-stimulation
#3
Jungmin Seo, Jee Hye Wee, Jeong Hoan Park, Pona Park, Jeong-Whun Kim, Sung June Kim
OBJECTIVE: A novel nerve cuff electrode with embedded magnets was fabricated and developed. In this study, a pair of magnets was fully embedded and encapsulated in a liquid crystal polymer (LCP) substrate to utilize magnetic force in order to replace the conventional installing techniques of cuff electrodes. In vitro and in vivo experiments were conducted to evaluate the feasibility of the magnet-embedded nerve cuff electrode (MENCE). Lastly, several issues pertaining to the MENCE such as the cuff-to-nerve diameter ratio, the force of the magnets, and possible concerns were discussed in the discussion section...
December 2016: Journal of Neural Engineering
https://www.readbyqxmd.com/read/27732789/obstructive-sleep-apnea-update-and-future
#4
Diane C Lim, Allan I Pack
Obstructive sleep apnea (OSA) is a worldwide disease whose prevalence is increasing as obesity rates increase. The link between obesity and OSA is likely to be the deposition of fat in the tongue, compromising upper airway size. The role of obesity varies in different ethnic groups, with Chinese being particularly sensitive to increases in weight. OSA lends itself to a personalized approach to diagnosis and therapy. For example, different clinical OSA subtypes likely benefit from therapy in different ways. Hypoglossal nerve stimulation is a useful second-line therapy in patients who cannot tolerate continous positive airway pressure (CPAP) machines or intraoral devices...
October 5, 2016: Annual Review of Medicine
https://www.readbyqxmd.com/read/27720458/upper-airway-stimulation-therapy
#5
REVIEW
Katherine Koral Green, B Tucker Woodson
Traditional upper airway surgery directly modifies skeletal and soft tissue structures surrounding the airway to treat obstructive sleep apnea (OSA). Upper airway stimulation (UAS) attempts to treat upper airway obstruction and OSA by stimulating the hypoglossal nerve. The Inspire II implant has been approved for clinical UAS. Basic science data support that UAS prevents obstruction and improves airflow. Clinical results demonstrate that UAS improves respiratory sleep metrics and improves both objective and subjective self-reported sleep and quality-of-life outcomes...
December 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27689226/-hypoglossal-nerve-stimulation-in-patients-with-cpap-failure-evolution-of-an-alternative-treatment-for-patients-with-obstructive-sleep-apnea
#6
C Heiser, B Hofauer
Obstructive sleep apnea (OSA) is a common disease in western industrialized countries with increasing prevalence. Gold standard of therapy is nocturnal positive pressure ventilation by continuous positive airway pressure (CPAP). Due to complications and side effects of ventilation, therapy adherence is limited. Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep. The aim of this work is to provide an overview of the history and current state of scientific knowledge of this therapy in the treatment of OSA...
September 29, 2016: HNO
https://www.readbyqxmd.com/read/27572120/upper-airway-stimulation-therapy-a-novel-approach-to-managing-obstructive-sleep-apnea
#7
REVIEW
Ryan J Soose, M Boyd Gillespie
OBJECTIVES: Review the role of upper airway stimulation (UAS) therapy in the management of moderate to severe obstructive sleep apnea (OSA). DATA SOURCES: A literature search was performed of PubMed and Medline using the search terms clinical trial; obstructive sleep apnea; upper airway stimulation; hypoglossal stimulation; hypoglossal nerve; Inspire; and ImThera. REVIEW METHODS: All published clinical trials of currently available devices were reviewed...
September 2016: Laryngoscope
https://www.readbyqxmd.com/read/27572119/updates-of-operative-techniques-for-upper-airway-stimulation
#8
REVIEW
Clemens Heiser, Erica Thaler, Maurits Boon, Ryan J Soose, B Tucker Woodson
Selective upper airway stimulation has been established as an additional treatment for obstructive sleep apnea (OSA). Essential for the treatment is the precise placement of the cuff electrode for select branches of the hypoglossal nerve, which innervate the protrusors and stiffeners of the tongue. A direct approach to the distal hypoglossal nerve has been established to achieve this goal. For surgeons, detailed knowledge of this anatomy is vital. Another decisive step is the placement of the sensing lead between the intercostal muscles...
September 2016: Laryngoscope
https://www.readbyqxmd.com/read/27435704/sternocleidomastoid-innervation-from-an-aberrant-nerve-arising-from-the-hypoglossal-nerve-a-prospective-study-of-160-neck-dissections
#9
Peter A Brennan, Peyman Alam, Mostafa Ammar, Constantine Tsiroyannis, Eirini Zagkou, Susan Standring
BACKGROUND: Anatomical variants of the spinal root of the accessory nerve and cervical plexus are well known but other variants are exceptionally rare. METHODS: A prospective study of 160 selective neck dissections was undertaken following an index case, where a presumed C1 nerve (travelling with the hypoglossal nerve) was found to innervate sternocleidomastoid (SCM). A search was subsequently made for this variant while not compromising the neck dissection surgery itself...
July 19, 2016: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/27424823/origins-of-and-implementation-concepts-for-upper-airway-stimulation-therapy-for-obstructive-sleep-apnea
#10
REVIEW
Kingman P Strohl M D, Jonathan Baskin M D, Colleen Lance M D, Diana Ponsky M D, Mark Weidenbecher M D, Madeleine Strohl B A, Motoo Yamauchi M D
Upper airway stimulation, specifically hypoglossal (CN XII) nerve stimulation, is a new, alternative therapy for patients with obstructive sleep apnea hypopnea syndrome who cannot tolerate positive airway pressure, the first-line therapy for symptomatic patients. Stimulation therapy addresses the cause of inadequate upper airway muscle activation for nasopharyngeal and oropharyngeal airway collapse during sleep. The purpose of this report is to outline the development of this first-in-class therapy and its clinical implementation...
July 2016: Respiratory Investigation
https://www.readbyqxmd.com/read/27411337/sonographic-evaluation-of-tongue-motions-during-upper-airway-stimulation-for-obstructive-sleep-apnea-a-pilot-study
#11
Benedikt Hofauer, Kingman Strohl, Andreas Knopf, Murat Bas, Markus Wirth, Konrad Stock, Clemens Heiser
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...
July 13, 2016: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/27345949/nerve-monitoring-guided-selective-hypoglossal-nerve-stimulation-in-obstructive-sleep-apnea-patients
#12
Clemens Heiser, Benedikt Hofauer, Luke Lozier, B Tucker Woodson, Thomas Stark
OBJECTIVE/HYPOTHESIS: Selective stimulation of the upper airway is a new therapy for obstructive sleep apnea. The aim of the study was to determine if a selective nerve integrity monitoring (NIM) system could aid in precise placement of the cuff electrode in selective upper-airway stimulation. STUDY DESIGN: Single-center, prospective clinical trial. METHODS: Twenty patients who received a selective upper-airway stimulation system (Inspire Medical Systems, Maple Grove, MN) were implanted by using a NIM system...
June 27, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27299890/recent-developments-in-the-diagnosis-and-treatment-of-obstructive-sleep-apnea-english-version
#13
B A Stuck, J T Maurer
Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography...
June 14, 2016: HNO
https://www.readbyqxmd.com/read/27244805/hypoglossal-nerve-stimulator-implantation-in-an-adolescent-with-down-syndrome-and-sleep-apnea
#14
Gillian R Diercks, Donald Keamy, Thomas Bernard Kinane, Brian Skotko, Allison Schwartz, Ellen Grealish, John Dobrowski, Ryan Soose, Christopher J Hartnick
Obstructive sleep apnea (OSA) is more common in children with Down syndrome, affecting up to 60% of patients, and may persist in up to 50% of patients after adenotonsillectomy. These children with persistent moderate to severe OSA require continuous positive airway pressure, which is often poorly tolerated, or even tracheotomy for severe cases. The hypoglossal nerve stimulator is an implantable device that produces an electrical impulse to the anterior branches of the hypoglossal nerve, resulting in tongue protrusion in response to respiratory variation...
May 2016: Pediatrics
https://www.readbyqxmd.com/read/27134515/treatments-for-obstructive-sleep-apnea
#15
Michael W Calik
OBJECTIVE: To review the efficacy of current treatment options for adults with obstructive sleep apnea (OSA). METHODS: Review of the literature. RESULTS: OSA, characterized by repetitive ≥ 10-second interruptions (apnea) or reductions (hypopnea) in airflow, is initiated by partial or complete collapse in the upper airway despite respiratory effort. When left untreated, OSA is associated with comorbid conditions, such as cardiovascular and metabolic diseases...
April 2016: Journal of Clinical Outcomes Management: JCOM
https://www.readbyqxmd.com/read/27049312/vagal-nerve-stimulation-attenuates-il-6-and-tnf%C3%AE-expression-in-respiratory-regions-of-the-developing-rat-brainstem
#16
Rhaya L Johnson, Samuel T Murray, David K Camacho, Christopher G Wilson
Pre-term infants are at greater risk for systemic infection due to an underdeveloped immune system. Airway infection results in immune up-regulation of early pro-inflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα) in the brainstem. Current treatment for neonatal infection involves antibiotic administration. We previously showed that LPS injected into the trachea of neonatal rats causes changes in breathing and in IL-1β expression in the nucleus tractus solitarii (NTS) and hypoglossal motor nucleus (XII)...
July 15, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27010361/targeted-hypoglossal-nerve-stimulation-for-the-treatment-of-obstructive-sleep-apnea-six-month-results
#17
Michael Friedman, Ofer Jacobowitz, Michelle S Hwang, Wolfgang Bergler, Ingo Fietze, Philippe Rombaux, Gimbada B Mwenge, Sreeya Yalamanchali, John Campana, Joachim T Maurer
OBJECTIVES/HYPOTHESIS: This feasibility study was designed to show the preliminary safety and efficacy of targeted hypoglossal neurostimulation (THN), and to identify baseline predictors of successful therapy. STUDY DESIGN: Open-label, prospective, multicenter, single-arm cohort study, conducted at seven centers in the U.S.A. and Europe. METHODS: Forty-six participants with moderate to severe obstructive sleep apnea (OSA), failing or intolerant of continuous positive airway pressure, were implanted...
March 24, 2016: Laryngoscope
https://www.readbyqxmd.com/read/26980908/upper-airway-stimulation-for-osa-early-adherence-and-outcome-results-of-one-center
#18
David T Kent, Jake J Lee, Patrick J Strollo, Ryan J Soose
OBJECTIVE: To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA). STUDY DESIGN: Case series with chart review. SETTING: Academic sleep medicine center. SUBJECTS AND METHODS: The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system...
July 2016: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/26796478/-implantable-nerve-stimulation-for-obstructive-sleep-apnea-hypopnea-syndrome
#19
Lidia Afonso Delgado, Jean-Arthur Micoulaud Franchi, Pierre-Jean Monteyrol, Pierre Philip
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder that has been identified as a contributor to cardiovascular disease making it a major public health problem. Continuous positive airway pressure is the standard treatment but compliance is suboptimal. Mandibular advancement devices and surgery have limited indications, inconstant efficiency and potential irreversible side effects. Stimulation of the hypoglossal nerve, that innervates the genioglossus, a protrusor muscle of the tongue, is now a new treatment option for moderate and severe cases of OSAHS...
February 2016: La Presse Médicale
https://www.readbyqxmd.com/read/26700261/hypoglossal-nerve-stimulation-rescue-surgery-after-multiple-multilevel-procedures-for-obstructive-sleep-apnea
#20
Madeleine Strohl, Kingman Strohl, J Martin Palomo, Diana Ponsky
Hypoglossal nerve stimulation (HNS) is a new procedure offered for the treatment of moderate-to-severe obstructive sleep apnea (OSA) that has been shown to decrease the severity and symptoms of OSA in select patients. We report on a case of a patient with persistent symptoms and findings of OSA despite a history of multiple multilevel procedures, including an uvulopalatopharyngoplasty (UPPP) with revision, a genioglossus advancement, and a maxillomandibular advancement. The patient then underwent HNS with significant improvement of his symptoms and severity...
January 2016: American Journal of Otolaryngology
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