Journal article
Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea
American journal of respiratory and critical care medicine, Vol.185(4), pp.420-426
2012
PMCID: PMC3297092
PMID: 22135343
Abstract
Rationale: Hypoglossal nerve stimulation (HGNS) recruits lingual muscles, reduces pharyngeal collapsibility, and treats sleep apnea.
Objectives: We hypothesized that graded increases in HGNS relieve pharyngeal obstruction progressively during sleep.
Methods: Responses were examined in 30 patients with sleep apnea who were implanted with an HGNS system. Current (milliampere) was increased stepwise during non-REM sleep. Frequency and pulse width were fixed. At each current level, stimulation was applied on alternating breaths, and responses in maximal inspiratory airflow (VImax) and inspiratory airflow limitation (IFL) were assessed. Pharyngeal responses to HGNS were characterized by the current levels at which VImax first increased and peaked (flow capture and peak flow thresholds), and by the VImax increase from flow capture to peak (ΔVImax).
Measurements and Main Results: HGNS produced linear increases in VImax from unstimulated levels at flow capture to peak flow thresholds (215 ± 21 to 509 ± 37 ml/s; mean ± SE; P < 0.001) with increasing current from 1.05 ± 0.09 to 1.46 ± 0.11 mA. VImax increased in all patients and IFL was abolished in 57% of patients (non-IFL subgroup). In the non-IFL compared with IFL subgroup, the flow response slope was greater (1241 ± 199 vs. 674 ± 166 ml/s/mA; P < 0.05) and the stimulation amplitude at peak flow was lower (1.23 ± 0.10 vs. 1.80 ± 0.20 mA; P < 0.05) without differences in peak flow.
Conclusions: HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in most patients and IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.
Details
- Title
- Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea
- Authors/Creators
- Alan R. Schwartz - Johns Hopkins UniversityMaree Barnes - Austin HospitalDavid Hillman - Sir Charles Gairdner HospitalAtul Malhotra - Brigham and Women's HospitalEric Kezirian - University of California, San FranciscoPhilip L. Smith - Johns Hopkins UniversityThomas Hoegh - College Station Medical CenterDaniel Parrish - College Station Medical CenterPeter R. Eastwood - Sir Charles Gairdner Hospital
- Publication Details
- American journal of respiratory and critical care medicine, Vol.185(4), pp.420-426
- Publisher
- Amer Thoracic Soc
- Number of pages
- 7
- Grant note
- R01HL050381 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) Apnex Medical, Inc. HL50381 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Identifiers
- 991005592644007891
- Copyright
- © 2012 by the American Thoracic Society
- Murdoch Affiliation
- Vice Chancellery
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.137 Sleep Science & Circadian Systems
- 1.137.382 Obstructive Sleep Apnea
- Web Of Science research areas
- Critical Care Medicine
- Respiratory System
- ESI research areas
- Clinical Medicine