Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York.
Division of Otolaryngology-Head and Neck Surgery, Stony Brook Medicine, Stony Brook, New York.
J Clin Sleep Med. 2022 May 1;18(5):1327-1333. doi: 10.5664/jcsm.9852.
Hypoglossal nerve stimulation (HGNS) is an effective alternative treatment for obstructive sleep apnea that acts by opening the airway via selective stimulation of nerve fibers that innervate tongue muscles that protrude (genioglossus) and stiffen the tongue (transverse and vertical) while avoiding nerve fibers that innervate tongue muscles that retract the tongue (styloglossus and hyoglossus). There remains a subset of postoperative patients who fail to adequately respond to HGNS, in some cases due to mixed activation of muscles that simultaneously protrude and retract the tongue. This study aims to characterize the relationship between neurophysiological data from individual tongue muscle activation during intraoperative electromyographic recordings and postoperative apnea-hypopnea index responses to HGNS.
A single-institution review of 46 patients undergoing unilateral HGNS implantation for obstructive sleep apnea. Patients were separated into and through comparison of pre and postoperative apnea-hypopnea index. Neurophysiological data included electromyographic responses of the genioglossus, styloglossus/hyoglossus, intrinsic/vertical, and hyoglossus (neck) muscles to intraoperative stimulation using unipolar (- to - and o to o) and bipolar (+ to +) settings.
The overall treatment success rate was 61% as determined by a postoperative apnea-hypopnea index < 20 events/h with a greater than 50% AHI reduction. We observed no statistically significant relationships between treatment response and individual muscle responses. However, we did note that increasing body mass index was correlated with worse postoperative responses.
Although we noted a significant subgroup of clinical nonresponders to HGNS postoperatively, these patients were not found to exhibit significant inclusion of tongue retractors intraoperatively on neurophysiological analysis. Further research is needed to delineate additional phenotypic factors that may contribute to HGNS treatment responses.
Wang D, Modik O, Sturm JJ, et al. Neurophysiological profiles of responders and nonresponders to hypoglossal nerve stimulation: a single-institution study. . 2022;18(5):1327-1333.
舌下神经刺激（HGNS）是一种有效的治疗阻塞性睡眠呼吸暂停的替代方法，通过选择性刺激支配伸出（颏舌肌）和使舌头变硬（横向和垂直）的舌肌神经纤维来打开气道，同时避免支配缩回舌头的舌肌神经纤维（舌骨舌肌和舌下肌）。仍有一部分术后患者对 HGNS 反应不足，在某些情况下，这是由于同时伸出和缩回舌头的肌肉混合激活所致。本研究旨在描述术中肌电图记录时单个舌肌激活的神经生理数据与 HGNS 术后呼吸暂停低通气指数反应之间的关系。
对 46 例因阻塞性睡眠呼吸暂停接受单侧 HGNS 植入的患者进行单机构回顾。通过比较术前和术后呼吸暂停低通气指数，将患者分为 和 。神经生理数据包括颏舌肌、舌骨舌肌/舌下肌、固有肌/垂直肌和舌下肌（颈部）对术中刺激的肌电图反应，刺激采用单极（-至-和 o 至 o）和双极（+至+）设置。
术后呼吸暂停低通气指数<20 次/小时，AHI 降低>50%，总体治疗成功率为 61%。我们没有观察到治疗反应与单个肌肉反应之间存在统计学上的显著关系。然而，我们确实注意到体重指数增加与术后反应较差相关。
尽管我们注意到术后 HGNS 临床无反应者的一个显著亚组，但在神经生理分析中，这些患者并未发现明显包含舌回缩肌。需要进一步研究以确定可能有助于 HGNS 治疗反应的其他表型因素。
Wang D, Modik O, Sturm JJ, et al. 对舌下神经刺激（HGNS）的反应者和非反应者的神经生理谱：单机构研究。 2022;18(5):1327-1333.
