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Chest. 2018 Dec;154(6):1435-1447. doi: 10.1016/j.chest.2018.08.1070. Epub 2018 Sep 14.

Neurostimulation Treatment of OSA.

Author information

1
Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: tfleury2@jhmi.edu.
2
Department of Medicine, Bnai Zion Medical Center, Technion, Haifa, Israel.
3
Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil.
4
Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
5
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD.

Abstract

Over the past 30 years, hypoglossal nerve stimulation has moved through a development pathway to become a viable treatment modality for patients with OSA. Initial pilot studies in animals and humans laid the conceptual foundation for this approach, leading to the development of fully implantable stimulating systems for therapeutic purposes. These devices were then shown to be both safe and efficacious in feasibility studies. One such closed-loop stimulating device was found to be effective in treating a limited spectrum of apneic patients and is currently approved by the US Food and Drug Administration for this purpose. Another open-loop stimulating system is currently being rigorously tested in a pivotal trial. Collectively, clinical trials of hypoglossal nerve stimulating systems have yielded important insights that can help optimize therapeutic responses to hypoglossal nerve stimulation. These insights include specific patient selection criteria and methods for delivering stimulation to specific portions of the hypoglossal nerve and/or genioglossus muscle. New approaches for activating efferent and afferent motor pathways are currently in early-stage laboratory development and hold some long-term promise as a novel therapy.

KEYWORDS:

OSA; hypoglossal nerve stimulation; upper airway stimulation

PMID:
30222959
PMCID:
PMC6335261
[Available on 2019-12-01]
DOI:
10.1016/j.chest.2018.08.1070
[Indexed for MEDLINE]

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