Obstructive Sleep Apnea affects 2-6% of the adult population and is a health problem of the first magnitude. Patient management strategies are diverse, always personalized, and carried out within multidisciplinary teams.
Neurostimulation systems have various applications in medicine. The number of patients with implantable or semi-implantable systems with different indications is increasing every day: the traditional “pacemakers”, systems for the treatment of pain, epilepsy or other neurological diseases, or cochlear implants. In 2001, electrical stimulation systems for the hypoglossal nerve began to be used specifically for the treatment of Sleep Apnea1.
Airway obstruction in this disease is caused by a collapse of the pharyngeal structures during sleep. Treatment with Continuous Positive Airway Pressure (CPAP) equipment prevents this collapse by maintaining increased pressure in the upper airway lumen through a nasal or facial mask, provided by an external “machine.” There are many other management strategies, including a number of surgical procedures. In recent years, Robotic Surgery has expanded the range of options available for the management of the base of the tongue.
The treatment of Sleep Apnea with neurostimulation is carried out by applying an electrical stimulus to the hypoglossal nerve, responsible for the mobility of the tongue. This is done during sleep, so that the muscle tone of the tongue is maintained, preventing it from falling backward and collapsing the pharynx. There are four devices. The first, from Apnex Medical, was never commercialized2. Inspire is the device with which there is the most clinical experience3,4. The ImThera / LivaNova5,6 device is currently undergoing a redesign. The Genio system is the latest to hit the market7. It will be implanted by expert surgeons selected in each country. Learn the details at https://genio.nyxoah.com/.
Although in practice the indications for Robotic Surgery and Neurostimulation Systems overlap, conceptually the resection and volume reduction strategy (robotics) would be indicated when the excess volume is basically dependent on lymphoid tissue (lingual tonsil), and the stimulation when it is mainly muscular. Your surgeon will explain these differences to you in detail and advise you on the best strategy for your particular case.
1Schwartz AR, Bennett ML, Smith PL et al. Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2001;127:1216-1223
2Eastwood PR, Barnes M, Walsh JH el al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 2011;34:1479-1486
3Strollo PJ Jr, Soose RJ, Maurer JT el al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 2014;370:139-149
4Woodson BT, Strohl KP, Soose RJ et al. 27.Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngol Head Neck Surg 2018;159:194-202
5Zaidi FN, Meadows P, Jacobowitz O, Davidson TM. Tongue anatomy and physiology, the scientific basis for a novel targeted neurostimulation system designed for the treatment of obstructive sleep apnea. Neuromodulation 2013;16:376-386
6Friedman M, Jacobowitz O, Hwang MS et al. Targeted hypoglossal nerve stimulation for the treatment of obstructive sleep apnea: Six-month results. Laryngoscope 2016;126:2618-2623
7Eastwood PR, Barnes M, MacKay SG et al. Bilateral Hypoglossal Nerve Stimulation for Treatment of Adult Obstructive Sleep Apnea. Eur Respir J 2020;55:1901320.
Head and Neck Robotic Surgery 