Otolaryngology–Head and Neck Surgery
Hypoglossal Nerve Stimulation
Treatment of obstructive sleep apnea (OSA) is critical to improving quality of life as well as long-term heart and brain health. For adults with moderate to severe OSA who are unable to tolerate positive airway pressure therapy, hypoglossal nerve stimulation, or upper airway stimulation, has been a major advance in OSA treatment.
The hypoglossal nerve stimulator is an implanted medical device that reduces the occurrence of OSA by electrically stimulating the hypoglossal nerve, which causes tongue movement. This stimulation is timed with breathing to relieve upper airway obstruction. The hypoglossal nerve stimulation system is fully implanted beneath the skin and controlled with a remote, allowing patients to sleep free from devices on the face or in the mouth.
The current FDA-approved device is made by Inspire Medical Systems© and has been available since 2014. Since that time, more than 6,000 hypoglossal nerve stimulator implants have been placed around the world with excellent results in terms of bed partner and patient satisfaction as well as measures of sleep apnea, snoring, and quality of life improvement.
While we do not discourage anyone from seeking help with obstructive sleep apnea management, the Inspire Medical Systems© hypoglossal nerve stimulator has certain criteria for candidacy:
- Age over 22 years
- Moderate to severe obstructive sleep apnea (apnea hypopnea index over 15/hr)
- Inability to tolerate positive airway pressure (CPAP, BiPAP, BPAP)
- Healthy enough to undergo surgery
- Body mass index of less than 35kg/m2
- Drug-induced sleep endoscopy (see below)
The process for obtaining a hypoglossal nerve stimulator is outlined below:
- Consultation to determine eligibility and discuss the procedure in detail. Appointments can be made by calling 617-573-3793 and pressing option 2. Please bring your most recent sleep study results.
- Drug induced sleep endoscopy (DISE) is a brief outpatient procedure that reproduces sleep apnea to determine what type of airway collapse you experience at night.
- Follow up to discuss DISE results and repeat discussion of the procedure.
- Insurance approval. Many insurance companies cover the cost of the device whereas others require that we proceed through an appeals process.
- Implantation is an outpatient procedure that takes approximately 2 hours. You go home with mild pain medications but need to reduce activity for about 1 week.
- Activation visit occurs at 1 month and is when your device is turned on for the first time. We show you how to use the remote then you begin to use the therapy at home.
- An in lab titration sleep study is performed approximately 3 months later. This is a sleep study done with the hypoglossal nerve stimulator on to determine how well it is working and to make adjustments as needed.
Our Lead Surgeon
At Mass. Eye and Ear, we have one surgeon specially trained in hypoglossal nerve stimulation, Phillip Huyett, MD, who accepts adult patients only.