University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Ravdin 5, Philadelphia, PA, USA.
Hospital Samaritano, São Paulo, Brazil.
J Med Case Rep. 2023 May 6;17(1):187. doi: 10.1186/s13256-023-03877-2.
Literature has demonstrated hypoglossal nerve stimulation to be a safe and effective treatment for patients with obstructive sleep apnea nonadherent to positive airway pressure therapy. However, the recommended criteria for patient selection are still unable to identify all the unresponsive patients, highlighting the need for improved understanding about hypoglossal nerve stimulation for obstructive sleep apnea.
A 48-year-old Caucasian male patient with obstructive sleep apnea had been successfully treated with electrical stimulation of the hypoglossal nerve trunk, documented by level 1 polysomnography data. However, due to snoring complaints, he underwent postoperation drug-induced sleep endoscopy for evaluation of electrode activation during upper airway collapse, aiming to improve electrostimulation parameters. Concurrent surface electromyography of the suprahyoid muscles and masseter was obtained. Activation of electrodes 2, 3, and 6 promoted upper airway opening most strongly at the velopharynx and tongue base during drug-induced sleep endoscopy. The same channels also significantly increased the electrical activity on suprahyoid muscles bilaterally, but predominantly on the stimulated side (right). The masseters also presented a considerable asymmetry in electrical potential on the right side (> 55%).
Beyond the genioglossus muscle, our findings demonstrate recruitment of other muscles during hypoglossal nerve stimulation, which may be attributed to the electrical stimulation of the nerve trunk. This data provides new insights on how stimulation of the hypoglossal nerve trunk may contribute to obstructive sleep apnea treatment.
文献表明，舌下神经刺激对于不能耐受气道正压治疗的阻塞性睡眠呼吸暂停患者是一种安全有效的治疗方法。然而，推荐的患者选择标准仍然无法识别所有无反应的患者，这凸显了需要更好地了解舌下神经刺激治疗阻塞性睡眠呼吸暂停。
一名 48 岁的白人男性阻塞性睡眠呼吸暂停患者，通过 1 级多导睡眠图数据证实接受舌下神经干电刺激治疗成功。然而，由于打鼾投诉，他接受了术后药物诱导睡眠内镜检查，以评估上气道塌陷期间电极的激活情况，旨在改善电刺激参数。同时获得了颏舌肌和咬肌的表面肌电图。在药物诱导睡眠内镜检查期间，电极 2、3 和 6 的激活在上咽部和舌根部最强烈地促进了上气道开放。相同的通道也显著增加了颏舌肌双侧的电活动，但主要在受刺激侧（右侧）。右侧的咬肌的电潜力也存在相当大的不对称性（>55%）。
除了颏舌肌之外，我们的发现还表明在舌下神经刺激期间会募集其他肌肉，这可能归因于神经干的电刺激。这些数据提供了关于舌下神经干刺激如何有助于治疗阻塞性睡眠呼吸暂停的新见解。
