TREATING OSA WITH HYPOGLOSSAL NERVE STIMULATION
Treating Obstructive Sleep Apnea with Hypoglossal Nerve Stimulation
Peter R. Eastwood, PhD1,2; Maree Barnes, MBBS3; Jennifer H. Walsh, PhD1,2; Kathleen J. Maddison, BSc1,2; Geoffrey Hee, MBBS; Alan R. Schwartz, MD5; Philip L. Smith, MD5; Atul Malhotra, MD6; R. Douglas McEvoy, MBBS7,11,15; John R. Wheatley, MBBS, PhD8; Fergal J. O'Donoghue, MBBS, PhD3,4; Peter D. Rochford, BAppSc, GradDip (Bio Instr)3,9; Tom Churchward, RPSGT3; Matthew C. Campbell, MBBS3; Carsten E. Palme, MBBS10; Sam Robinson, MBBS11; George S. Goding, MD12; Danny J. Eckert, PhD13; Amy S. Jordan, PhD4; Peter G. Catcheside, PhD7,11,15; Louise Tyler, RN, RPSGT8,14; Nick A. Antic, MBBS, PhD7,11,15; Christopher J. Worsnop, MBBS, PhD3,4; Eric J. Kezirian, MD, MPH16; David R. Hillman, MBBS1
1Sir Charles Gairdner Hospital, Perth, Australia; 2University of Western Australia, Perth, Australia; 3Institute for Breathing and Sleep, Austin Health, Melbourne, Australia; 4University of Melbourne, Melbourne, Australia; 5Johns Hopkins School of Medicine, Baltimore, MD; 6Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 7Repatriation General Hospital, Adelaide, Australia; 8Westmead Hospital, Sydney, Australia; 9Austin Health, Melbourne, Australia; 10Westmead Private Hospital, Sydney, Australia; 11Flinders University, Adelaide, Australia; 12University of Minnesota, Minneapolis, MN; 13Brigham and Women's Hospital, Boston, MA; 14Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, Westmead, Australia; 15Adelaide Institute for Sleep Heath, Adelaide, Australia; 16University of California San Francisco, San Francisco, CA
Reduced upper airway muscle activity during sleep is fundamental to obstructive sleep apnea (OSA) pathogenesis. Hypoglossal nerve stimulation (HGNS) counteracts this problem, with potential to reduce OSA severity.
To examine safety and efficacy of a novel HGNS system (HGNS, Apnex Medical, Inc.) in treating OSA.
Twenty-one patients, 67% male, age (mean ± SD) 53.6 ± 9.2 years, with moderate to severe OSA and unable to tolerate continuous positive airway pressure (CPAP).
Each participant underwent surgical implantation of the HGNS system in a prospective single-arm interventional trial. OSA severity was defined by apnea-hypopnea index (AHI) during in-laboratory polysomnography (PSG) at baseline and 3 and 6 months post-implant. Therapy compliance was assessed by nightly hours of use. Symptoms were assessed using the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Calgary Sleep Apnea Quality of Life Index (SAQLI), and the Beck Depression Inventory (BDI).
HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement.
HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms.
Eastwood PR; Barnes M; Walsh JH; Maddison KJ; Hee G; Schwartz AR; Smith PL; Malhotra A; McEvoy RD; Wheatley JR; O'Donoghue FJ; Rochford PD; Churchward T; Campbell MC; Palme CE; Robinson S; Goding GS; Eckert DJ; Jordan AS; Catcheside PG; Tyler L; Antic NA; Worsnop CJ; Kezirian EJ; Hillman DR. Treating obstructive sleep apnea with hypoglossal nerve stimulation. SLEEP 2011;34(11):1479-1486.