The more common treatments of obstructivesleep apnea—continuous positive airway pressure (CPAP)or bilevel therapy—may be difficult to tolerate. As the condition can have serious, and evenfatal, consequences, you may be motivated to seek out alternative options.
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Surgery may seem like a desirable option and the use of a device called a hypoglossal nerve stimulator might sound appealing. How does the surgery for the hypoglossal nerve stimulator, calledInspirein the United States, treat obstructive sleep apnea? Learn how an implanted tongue pacemaker device works.
What the Hypoglossal Nerve Stimulator Is
It can effectively treat moderate to severe obstructive sleep apnea. This means that at baseline there are more than 15 partial or complete blockages of the throat per hour of sleep based on testing. If treatment with CPAP or bilevel therapy is not tolerated, this may be a reason to consider the hypoglossal nerve stimulator.
How It Works
There are certain conditions that might predispose someone to this sort of obstruction. The airway may collapse due to a loss of muscle tone that occurs as part of rapid eye movement (REM) sleep.It may be more prevalent when sleeping on the back. It may become more common with aging. It is certainly more likely among people who are overweight.
The use ofalcoholand medications that relax muscles might also predispose toward it.In addition, there are parts of our anatomy that might lead to sleep apnea. For example, a large tongue (called macroglossia) or a small or recessed lower jaw (calledretrognathia) may lead to airway obstruction.
What Conditions It Treats
The hypoglossal nerve stimulator is currently being used for the treatment of moderate to severe obstructive sleep apnea in adults. But it can be used only in people with abody mass index (BMI)less than 32. Sleep endoscopy is used to ensure that there is not a concentric (complete) collapse of the airway as these individuals would not respond as well to the treatment. It would not be helpful in individuals withcentral sleep apnea.It might also improvesnoring, but it is not approved solely to treat this condition.
Surgical Procedure for Placement
The hypoglossal nerve stimulator must be placed surgically. The main part of the device is implanted under the skin of the upper chest wall, much like a pacemaker. This component includes the battery as well as the part that generates the electrical stimulation. From here, there is a wire that actually stimulates the tongue extends to the hypoglossal nerve. A second wire is directed to the chest wall to detect the breathing pattern.
The Risks of the Hypoglossal Nerve Stimulator
The most common risks with the use of a hypoglossal nerve stimulator are those associated with the placement surgery itself. If your underlying health and medical conditions put you at higher risk for any surgery, then this might not be a good option for you. As with any surgery, there is a risk of bleeding and infection.
The hypoglossal nerve stimulator could potentially dysfunction. This might mean that it stops working entirely. It may also fire or activate inappropriately, leading to discomfort during wakefulness. The battery will eventually fail, requiring another surgery to swap out the implanted device (but not necessarily the wires that connect to the nerve or chest wall).
Alternatives to the Hypoglossal Nerve Stimulator
A Word From Verywell
If you wish to learn more about the hypoglossal nerve stimulator, you will likely need to be referred to a board-certified sleep or ear, nose, and throat (ENT) specialist who has expertise in the device.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Young T, Finn L, Peppard PE, et al.Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.Sleep. 2008;31(8):1071-8.Gagnadoux F, Jouvenot M, Meslier N, Priou P, Trzepizur W.Therapeutic alternatives to continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome.Presse Med. 2017;46(4):432-437. doi: 10.1016/j.lpm.2016.09.006Bugalho P, Mendonça M, Barbosa R, Salavisa M.The influence of sleep disordered breathing in REM sleep behavior disorder.Sleep Med. 2017;37:210-215. doi:10.1016/j.sleep.2017.05.012Nerfeldt P, Graf P, Borg S, Friberg D.Prevalence of high alcohol and benzodiazepine consumption in sleep apnea patients studied with blood and urine tests.Acta Otolaryngol. 2004;124(10):1187-90. doi:10.1080/00016480410017729White DP.Pathogenesis of obstructive and central sleep apnea.Am J Respir Crit Care Med. 2005;172(11):1363-70. doi:10.1164/rccm.200412-1631SOFood and Drug Administration.Inspire patient manual. 2014.Camacho M, Chang ET, Neighbors CLP, et al.Thirty-five alternatives to positive airway pressure therapy for obstructive sleep apnea: an overview of meta-analyses.Expert Rev Respir Med. 2018;12(11):919-929. doi:10.1080/17476348.2018.1522253Additional ReadingEastwood PR, Barnes M, Walsh JH, et al. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Sleep. 2011;34(11):1479-86. doi:10.5665/sleep.1380.Eisele DW, Schwartz AR, Smith PL. “Tongue Neuromuscular and Direct Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.“Otolaryngol Clin North Am. 2003;36(3):501-10.Kezirian, EJet al. “Electrical Stimulation of the Hypoglossal Nerve in the Treatment of Obstructive Sleep Apnea.“Sleep Med Rev. 2010 Oct;14(5):299-305.Oliven A. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Curr Opin Pulm Med. 2011;17(6):419-24. doi:10.1097/MCP.0b013e32834b7e65.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Young T, Finn L, Peppard PE, et al.Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.Sleep. 2008;31(8):1071-8.Gagnadoux F, Jouvenot M, Meslier N, Priou P, Trzepizur W.Therapeutic alternatives to continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome.Presse Med. 2017;46(4):432-437. doi: 10.1016/j.lpm.2016.09.006Bugalho P, Mendonça M, Barbosa R, Salavisa M.The influence of sleep disordered breathing in REM sleep behavior disorder.Sleep Med. 2017;37:210-215. doi:10.1016/j.sleep.2017.05.012Nerfeldt P, Graf P, Borg S, Friberg D.Prevalence of high alcohol and benzodiazepine consumption in sleep apnea patients studied with blood and urine tests.Acta Otolaryngol. 2004;124(10):1187-90. doi:10.1080/00016480410017729White DP.Pathogenesis of obstructive and central sleep apnea.Am J Respir Crit Care Med. 2005;172(11):1363-70. doi:10.1164/rccm.200412-1631SOFood and Drug Administration.Inspire patient manual. 2014.Camacho M, Chang ET, Neighbors CLP, et al.Thirty-five alternatives to positive airway pressure therapy for obstructive sleep apnea: an overview of meta-analyses.Expert Rev Respir Med. 2018;12(11):919-929. doi:10.1080/17476348.2018.1522253Additional ReadingEastwood PR, Barnes M, Walsh JH, et al. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Sleep. 2011;34(11):1479-86. doi:10.5665/sleep.1380.Eisele DW, Schwartz AR, Smith PL. “Tongue Neuromuscular and Direct Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.“Otolaryngol Clin North Am. 2003;36(3):501-10.Kezirian, EJet al. “Electrical Stimulation of the Hypoglossal Nerve in the Treatment of Obstructive Sleep Apnea.“Sleep Med Rev. 2010 Oct;14(5):299-305.Oliven A. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Curr Opin Pulm Med. 2011;17(6):419-24. doi:10.1097/MCP.0b013e32834b7e65.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Young T, Finn L, Peppard PE, et al.Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.Sleep. 2008;31(8):1071-8.Gagnadoux F, Jouvenot M, Meslier N, Priou P, Trzepizur W.Therapeutic alternatives to continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome.Presse Med. 2017;46(4):432-437. doi: 10.1016/j.lpm.2016.09.006Bugalho P, Mendonça M, Barbosa R, Salavisa M.The influence of sleep disordered breathing in REM sleep behavior disorder.Sleep Med. 2017;37:210-215. doi:10.1016/j.sleep.2017.05.012Nerfeldt P, Graf P, Borg S, Friberg D.Prevalence of high alcohol and benzodiazepine consumption in sleep apnea patients studied with blood and urine tests.Acta Otolaryngol. 2004;124(10):1187-90. doi:10.1080/00016480410017729White DP.Pathogenesis of obstructive and central sleep apnea.Am J Respir Crit Care Med. 2005;172(11):1363-70. doi:10.1164/rccm.200412-1631SOFood and Drug Administration.Inspire patient manual. 2014.Camacho M, Chang ET, Neighbors CLP, et al.Thirty-five alternatives to positive airway pressure therapy for obstructive sleep apnea: an overview of meta-analyses.Expert Rev Respir Med. 2018;12(11):919-929. doi:10.1080/17476348.2018.1522253
Young T, Finn L, Peppard PE, et al.Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.Sleep. 2008;31(8):1071-8.
Gagnadoux F, Jouvenot M, Meslier N, Priou P, Trzepizur W.Therapeutic alternatives to continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome.Presse Med. 2017;46(4):432-437. doi: 10.1016/j.lpm.2016.09.006
Bugalho P, Mendonça M, Barbosa R, Salavisa M.The influence of sleep disordered breathing in REM sleep behavior disorder.Sleep Med. 2017;37:210-215. doi:10.1016/j.sleep.2017.05.012
Nerfeldt P, Graf P, Borg S, Friberg D.Prevalence of high alcohol and benzodiazepine consumption in sleep apnea patients studied with blood and urine tests.Acta Otolaryngol. 2004;124(10):1187-90. doi:10.1080/00016480410017729
White DP.Pathogenesis of obstructive and central sleep apnea.Am J Respir Crit Care Med. 2005;172(11):1363-70. doi:10.1164/rccm.200412-1631SO
Food and Drug Administration.Inspire patient manual. 2014.
Camacho M, Chang ET, Neighbors CLP, et al.Thirty-five alternatives to positive airway pressure therapy for obstructive sleep apnea: an overview of meta-analyses.Expert Rev Respir Med. 2018;12(11):919-929. doi:10.1080/17476348.2018.1522253
Eastwood PR, Barnes M, Walsh JH, et al. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Sleep. 2011;34(11):1479-86. doi:10.5665/sleep.1380.Eisele DW, Schwartz AR, Smith PL. “Tongue Neuromuscular and Direct Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.“Otolaryngol Clin North Am. 2003;36(3):501-10.Kezirian, EJet al. “Electrical Stimulation of the Hypoglossal Nerve in the Treatment of Obstructive Sleep Apnea.“Sleep Med Rev. 2010 Oct;14(5):299-305.Oliven A. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Curr Opin Pulm Med. 2011;17(6):419-24. doi:10.1097/MCP.0b013e32834b7e65.
Eastwood PR, Barnes M, Walsh JH, et al. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Sleep. 2011;34(11):1479-86. doi:10.5665/sleep.1380.
Eisele DW, Schwartz AR, Smith PL. “Tongue Neuromuscular and Direct Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.“Otolaryngol Clin North Am. 2003;36(3):501-10.
Kezirian, EJet al. “Electrical Stimulation of the Hypoglossal Nerve in the Treatment of Obstructive Sleep Apnea.“Sleep Med Rev. 2010 Oct;14(5):299-305.
Oliven A. “Treating Obstructive Sleep Apnea With Hypoglossal Nerve Stimulation.“Curr Opin Pulm Med. 2011;17(6):419-24. doi:10.1097/MCP.0b013e32834b7e65.
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