Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN.
Chest. 2021 Mar;159(3):1212-1221. doi: 10.1016/j.chest.2020.10.010. Epub 2020 Oct 14.
Hypoglossal nerve stimulation (HNS) is an alternative treatment option for patients with OSA unable to tolerate positive airway pressure but implant criteria limit treatment candidacy. Previous research indicates that caudal tracheal traction plays an important role in stabilizing upper airway patency.
Does contraction of the sternothyroid muscle with ansa cervicalis stimulation (ACS), which pulls the pharynx caudally via thyroid cartilage insertions, increase maximum inspiratory airflow (Vmax)?
Hook-wire percutaneous electrodes were used to stimulate the medial branch of the right hypoglossal nerve and right branch of the ansa cervicalis innervating the sternothyroid muscle during propofol sedation. Vmax was assessed during flow-limited inspiration with a pneumotachometer.
Eight participants with OSA were studied using ACS with and without HNS. Compared with baseline, the mean Vmax increase with isolated ACS was 298%, or 473 mL/s (95% CI, 407-539). Isolated HNS increased mean Vmax from baseline by 285%, or 260 mL/s (95% CI, 216-303). Adding ACS to HNS during flow-limited inspiration increased mean Vmax by 151%, or 205 mL/s (95% CI, 174-236) over isolated HNS. Stimulation was significantly associated with increase in Vmax in both experiments (P < .001).
ACS independently increased Vmax during propofol sedation and drove further increases in Vmax when combined with HNS. The branch of the ansa cervicalis innervating the sternothyroid muscle is easily accessed. Confirmation of the ansa cervicalis as a viable neurostimulation target may enable caudal pharyngeal traction as a novel respiratory neurostimulation strategy for treating OSA.
舌下神经刺激（HNS）是一种治疗阻塞性睡眠呼吸暂停（OSA）患者的替代方法，这些患者不能耐受气道正压治疗，但植入标准限制了治疗的候选资格。先前的研究表明，尾气管牵引在维持上气道通畅方面起着重要作用。
通过刺激颈袢的胸锁乳突肌（通过甲状腺软骨插入物将咽腔向下拉），是否会增加最大吸气流量（Vmax）？
在异丙酚镇静期间，使用钩状电针经皮电极刺激右侧舌下神经的内侧支和支配胸锁乳突肌的右侧颈袢分支。在气流受限吸气时使用呼吸流速仪评估 Vmax。
对 8 名 OSA 患者进行了 ACS 联合和不联合 HNS 的研究。与基线相比，单独 ACS 的平均 Vmax 增加了 298%，或 473ml/s（95%CI，407-539）。单独 HNS 使 Vmax 从基线增加了 285%，或 260ml/s（95%CI，216-303）。在气流受限吸气时，将 ACS 与 HNS 联合应用可使平均 Vmax 增加 151%，或 205ml/s（95%CI，174-236），高于单独 HNS。在这两项实验中，刺激均与 Vmax 的增加显著相关（P<.001）。
ACS 可独立增加异丙酚镇静期间的 Vmax，与 HNS 联合应用时可进一步增加 Vmax。支配胸锁乳突肌的颈袢分支很容易触及。确认颈袢作为可行的神经刺激靶点可能使咽后牵引成为治疗 OSA 的新型呼吸神经刺激策略。
