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Dr Maria Suurna: Hypoglossal nerve stimulator and the ISSS research forum

Updated: Dec 10, 2021

Suurna MV, Jacobowitz O, Chang J, Koutsourelakis I, Smith D, Alkan U, D'Agostino M, Boon M, Heiser C, Hoff P, Huntley C, Kent D, Kominsky A, Lewis R, Maurer JT, Ravesloot MJ, Soose R, Steffen A, Weaver EM, Williams AM, Woodson T, Yaremchuk K, Ishman SL. Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions, and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum. J Clin Sleep Med. 2021 Dec 1;17(12):2477-2487. doi: 10.5664/jcsm.9542. PMID: 34279214.

We are excited to have the proceedings from the 2019 International Sleep Surgery Society Research Forum published in the July 2021 issue of the Journal of Clinical Sleep Medicine. The Research Forum was focused on the current state of implantable hypoglossal nerve stimulation (HGNS) as a treatment for moderate-to-severe obstructive sleep apnea (OSA) in positive airway pressure-intolerant patients.

Current state of evidence for HGNS therapy was discussed. The relative merits of the various outcome measures for therapy efficacy require further consideration. HGNS candidacy for patients with palatal complete concentric collapse or a body mass index (BMI) > 32 kg/m2 is a clear point for future research, as is the role of stimulation of the first cervical nerve in treatment outcome, most effective protocol for advanced device titration, and advantage of bilateral neurostimulation.

When considering patient candidacy for HGNS, the role of nasal structure, prior soft palate surgery, BMI, gender, age, craniofacial anatomy, and the presence of positional OSA are all current topics of research and may prove to be critical. Assessment of OSA phenotypes and pathophysiology, and specifically the role of critical closing airway pressure, loop gain, and arousal threshold, are all also emerging as tools to better understand the development of OSA and potentially predict surgical success or failure. Finally, interaction between neurological disorders, psychosocial factors, and comorbid sleep disorders such as insomnia and therapeutic efficacy of HGNS must be further explored.

In all, the 2019 ISSS Research Forum found that HGNS has proved to be an effective and rapidly progressing second-line treatment for OSA, and we were able to establish a comprehensive list of future research topics to better understand treatment effectiveness, patient candidacy, and the prediction of therapy success.

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