Nerve monitoring-guided selective hypoglossal nerve stimulation in obstructive sleep apnea patients.

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. The tongue motions were recorded during surgery and 2 months postoperatively from the transoral view and by transnasal endoscopy.

RESULTS: All patients exhibited consistent protrusion at tongue front and tongue base. The nerve monitoring system helped to place the cuff electrode around the protrusion and stiffening branches, while excluding the retractor branches of the hypoglossal nerve.

CONCLUSION: This report demonstrated a novel use of a NIM system to identify the functional separation between inclusion and exclusion branches of the hypoglossal nerve for implantation of a selective upper-airway stimulation system.

LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2852-2858, 2016.