Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
J Clin Sleep Med. 2023 May 1;19(5):947-955. doi: 10.5664/jcsm.10474.
The major goal of the study was to determine whether changes in tongue morphology under selective hypoglossal nerve therapy for obstructive sleep apnea were associated with alterations in airway patency during sleep when specific portions of the hypoglossal nerve were stimulated.
This case series was conducted at the Johns Hopkins Sleep Disorders Center at Johns Hopkins Bayview Medical Center. Twelve patients with apnea implanted with a multichannel targeted hypoglossal nerve-stimulating system underwent midsagittal ultrasound tongue imaging during wakefulness. Changes in tongue shape were characterized by measuring the vertical height and polar dimensions between tongue surface and genioglossi origin in the mandible. Changes in patency were characterized by comparing airflow responses between stimulated and adjacent unstimulated breaths during non-rapid eye movement sleep.
Two distinct morphologic responses were observed. Anterior tongue base and hyoid-bone movement (5.4 [0.4] to 4.1 [1.0] cm (median and [interquartile range]) with concomitant increases in tongue height (5.0 [0.9] to 5.6 [0.7] cm) were associated with decreases in airflow during stimulation. In contrast, comparable anterior hyoid movement (tongue protrusion from 5.8 [0.5] to 4.5 [0.9] cm) without significant increases in height (5.2 [1.6] to 4.6 [0.8] cm) were associated with marked increases in airflow during sleep.
Tongue protrusion with preservation of tongue shape predicted increases in patency, whereas anterior movement with concomitant increases in height were associated with decreased pharyngeal patency. These findings suggest that pharyngeal patency can be best stabilized by stimulating lingual muscles that maintain tongue shape while protruding the tongue, thereby preventing it from prolapsing posteriorly during sleep.
Fleury Curado T, Pham L, Otvos T, et al. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation. . 2023;19(5):947-955.
本研究的主要目的是确定在阻塞性睡眠呼吸暂停的选择性舌下神经治疗下，舌形态的变化是否与在刺激特定舌下神经部分时睡眠期间气道通畅性的改变有关。
该病例系列研究在约翰霍普金斯湾景医疗中心的约翰霍普金斯睡眠障碍中心进行。12 名接受多通道靶向舌下神经刺激系统植入的呼吸暂停患者在清醒时进行了舌中矢状面超声成像。通过测量舌表面与下颌颏舌肌起点之间的垂直高度和极向尺寸，来描述舌形状的变化。通过比较非快速眼动睡眠期间刺激和相邻未刺激呼吸之间的气流反应来描述通畅性的变化。
观察到两种不同的形态反应。舌前基底部和舌骨运动（5.4 [0.4] 至 4.1 [1.0]cm（中位数和[四分位间距]），同时舌高度增加（5.0 [0.9] 至 5.6 [0.7]cm）与刺激期间气流减少相关。相比之下，类似的前舌骨运动（舌前伸从 5.8 [0.5] 至 4.5 [0.9]cm）而高度无显著增加（5.2 [1.6] 至 4.6 [0.8]cm）与睡眠期间气流显著增加相关。
舌突出而保持舌形状预测通畅性增加，而前伸同时增加高度与咽腔通畅性降低相关。这些发现表明，通过刺激保持舌形状的舌肌，同时突出舌头，可以最好地稳定咽腔通畅性，从而防止其在睡眠期间向后脱垂。
Fleury Curado T, Pham L, Otvos T, et al. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation.. 2023;19(5):947-955.
