419 - Hypoglossal Nerve Stimulation

HypoglossalNerveStimulationfor Treatment ofObstructiveSleepApnea E D I T O R ’ S N O T E O bstructive sleep apnea (OSA) is one of several breathing disorders that occur during sleep, caus- ing respiration to become shallow or stop. Patients may stop breathing for a few seconds, up to several minutes, before breathing resumes. During normal sleep, the muscles of the throat relax, causing the passage to narrow. In patients with OSA, the airway becomes temporarily blocked by soft tissue (eg, the tongue, uvula or tonsils) cutting off the air to the trachea. According to a 2014 report by the American Academy of Sleep Medicine, 25 million adults in the Unit- ed States have OSA, with 26% of adults between the ages of 30 and 70 years having some degree of sleep apnea. 1 Risk factors for OSA include: obesity (BMI>30), middle age and older, male, diagnosed hyperten- sion, alcohol or sedative use, upper airway or facial abnormalities, smoking, family history, endocrine and metabolic disorders and a neck circumference greater than 17 inches in men and 16 inches in women. 2, 3 Sleep apnea often goes undiagnosed. Symptoms of the disease include excessive daytime sleepiness and lack of energy; snoring, irregular breathing, gasping, coughing or choking during sleep; restless sleep, including frequent nighttime urination; irritability, impatience or forgetfulness; morning headaches; and depression. 3, 4 Sleep apnea is a comorbidity associated with hypertension, obesity, depression, gastroesophageal reflux disease, diabetes mellitus, hypercholesterolemia and asthma. 4,5 Plus, patients with moderate to severe sleep apnea are 15 times more likely to be involved in an automobile accident due to their lack of sleep and reduced alertness. 4 The following article outlines a new surgical intervention for OSA that uses stimulation of the VII cra- nial nerve to eliminate obstruction of the airway. Three hypoglossal nerve stimulation systems are being studied extensively for their efficacy in different patient populations. Although the article highlights statis- tics from Korea, it provides a good review of the current literature and an outline of the surgical technique. 1. Rising prevalence of sleep apnea in U.S.threatens public health.AmericanAcademy of SleepMedicine website.Published Sept.29,2014. https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/.AccessedAug. 23, 2018. 2. Strohl, KP. Patient education: Sleep apnea in adults (Beyond the Basics). UpToDate® https://www.uptodate.com/contents/sleep-apnea- in-adults-beyond-the-basics?view=print. Updated Nov. 6, 2017.AccessedAug. 23, 2018. 3. Obstructive sleep apnea – adults.Medline Plus website.U.S.National Library of Medicine. https://medlineplus.gov/ency/article/000811. htm.AccessedAug. 23, 2018. 4. SleepApnea Facts and Figures.ResMed website .https://www.resmed.com/us/dam/documents/products/dental/Narval-CC/facts-and- figures/1015527r4_Narval_MRD_FactsandFigures_web.pdf. Published May 4, 2014.AccessedAug. 27, 2018. 5. Pinto JA, et al. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study. Int Arch Otorhinolaryngol .2016 Apr;10(2):145-150. doi:10.1055/s-0036-1579546. NOVEMBER 2018 | The Surgical Technologist | 495