Hypoglossal Nerve Service Team Photo (1)

What is involved in a hypoglossal nerve stimulation service?

Wednesday, January 24, 2024

Respiratory Futures spoke to [left to right] Yakubu Karagama (Consultant ENT Surgeon and Laryngologist), Krizzia Alvaran Lammas (Laryngology Nurse Practitioner) and Professor Joerg Steier (Professor of Respiratory and Sleep Medicine). Our experts shared with us information about what a hypoglossal nerve stimulation service involves, and how it can help patients across the UK.

Can you tell us a little about what hypoglossal nerve stimulation is, and what it is used for?

Hypoglossal nerve stimulation (HGNS) is an approved sleep apnoea treatment method that utilizes an implanted medical device developed by Inspire Medical Systems, Inc. This device received approval from the Food and Drug Administration in 2014 and CE Mark. HGNS is designed to address obstructive sleep apnea (OSA) by rhythmically stimulating the hypoglossal nerve in synchronization with the patient's breathing pattern. This stimulation effectively assists in maintaining an open and unobstructed airway for the patient while they are asleep.

What sort of patients are eligible to receive hypoglossal nerve stimulation as a treatment option?

HGNS placement is appropriate for specific individuals with moderate to severe obstructive sleep apnoea (OSA) with an AHI score ranging from 15 to 65, as determined by the U.S. Food and Drug Administration (FDA). Innovatively, HGNS is under investigation as an alternative to CPAP therapy for children and adolescents with Down syndrome, a population where up to 60% suffer from OSA and may struggle with traditional treatments like CPAP or tracheotomy. A study involving adolescents with Down Syndrome observed a notable reduction of over 50% in AHI scores with HGNS. The FDA recommends HGNS for patients who have previously failed or cannot tolerate positive airway pressure therapies. Since OSA patients may have varying airway structures and tongue collapsibility patterns during sleep, certain anatomical profiles are more suited for HGNS than others. It is essential to assess patients with drug-induced sleep endoscopy, and HGNS tends to be more effective in those with a body mass index (BMI) below 32.

Obstructive sleep apnoea (OSA) is a prevalent condition, affecting approximately 1.5 million adults in the UK. Surprisingly, up to 85% of these cases go undiagnosed, leaving patients untreated.

How is the multi-disciplinary team required to work together in order to deliver this service?

Collaborating within a multidisciplinary framework is essential to maximize patient benefits. It facilitates clinicians in deliberating complex cases and exchanging their expertise to identify the most effective treatment options for patients. This collaborative approach holds particular significance when selecting appropriate candidates for the treatment of individuals with obstructive sleep apnoea who have not experienced improvements following CPAP and are referred for consideration for hypoglossal nerve stimulation implant surgery.

What benefits may patients experience after receiving this treatment?

HGNS offers several advantages, including the elimination of the need for CPAP, effectiveness for patients unable to use CPAP for various reasons, the ability for patients to customize their stimulation levels, efficacy for individuals with moderate to severe obstructive sleep apnoea, and the absence of external connections, wires, or tubes. Patients can operate it conveniently through a remote control.

What do you hope the future of hypoglossal nerve stimulation looks like across the UK?

Obstructive sleep apnoea (OSA) is a prevalent condition, affecting approximately 1.5 million adults in the UK. Surprisingly, up to 85% of these cases go undiagnosed, leaving patients untreated. Undiagnosed OSA is closely linked to serious health issues such as hypertension, diabetes, stroke, and heart disease. Among the 15% who receive treatment, a significant portion fails to comply with CPAP therapy, resulting in untreated cases. In an early study, CPAP compliance after 5 years was only 68% (Ardle et al., 1999). Interestingly, despite advancements in mask design, materials, and positive airway pressure delivery methods, noncompliance rates have remained high at around 34% over the past two decades (Rotenberg et al., 2016). This suggests that the issue of non-compliance with CPAP therapy has persisted despite technical improvements. HGNS offers an alternative treatment to some of these patients.