Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Interdisciplinary Sleep Medicine Center, Berlin, Germany.
Adv Exp Med Biol. 2022;1384:351-372. doi: 10.1007/978-3-031-06413-5_21.
Hypoglossal nerve stimulation (HNS) has been shown to be a safe alternative in the treatment of moderate-to-severe obstructive sleep apnea (OSA). A recent meta-analysis of 12 studies by Costantino et al. indicated the surgical success rates at 55-75%, a reduction of the apnea hypopnea index (AHI) of 18 events/h, and a reduction of the Epworth Sleepiness Scale (ESS) of 2.9-5.3. After animal studies in the 1970s, the first trial on humans to decrease upper airway resistance by transcutaneous electrical stimulation of the genioglossus was reported in 1989. A separate stimulation of protruding and retracting muscles was realized in 1995 by fine-wire electrodes that were placed into the tongue transoral. Over the next years, several companies developed implantable devices for hypoglossal stimulation in OSA. Initially, devices were developed that used unilateral stimulation of the hypoglossal nerve. In 2014, a device for unilateral respiratory frequency-controlled hypoglossal stimulation finally received FDA approval after a successful phase III trial. In recent years, a device for bilateral breath rate-independent stimulation of the hypoglossal nerve has been added to these approaches as a new development. Accordingly, hypoglossal nerve stimulation, on the one hand, is now an established tool for patients with OSA when standard treatments are not satisfactory. Beyond that, hypoglossal stimulation is undergoing a continuous and impressive development like hardly any other field of surgical therapy for OSA.
舌下神经刺激（HNS）已被证明是治疗中重度阻塞性睡眠呼吸暂停（OSA）的安全替代方法。Costantino 等人最近对 12 项研究进行的荟萃分析表明，手术成功率为 55-75%，呼吸暂停低通气指数（AHI）降低 18 次/小时，嗜睡量表（ESS）降低 2.9-5.3。在 20 世纪 70 年代的动物研究之后，1989 年首次报道了通过经皮电刺激颏舌肌来降低上气道阻力的人体试验。1995 年，通过放置在口腔内的细电极实现了突出和缩回肌肉的单独刺激。在接下来的几年里，几家公司开发了用于 OSA 的舌下神经刺激植入设备。最初，开发了使用单侧舌下神经刺激的设备。2014 年，一种用于单侧呼吸频率控制的舌下神经刺激的设备在成功完成 III 期试验后终于获得了 FDA 的批准。近年来，作为一种新的发展，一种用于双侧呼吸频率独立刺激舌下神经的设备已被添加到这些方法中。因此，一方面，对于标准治疗不满意的 OSA 患者，舌下神经刺激现在是一种既定的治疗工具。除此之外，舌下神经刺激正在像 OSA 手术治疗的其他任何领域一样，经历着持续而令人印象深刻的发展。
