Effects of Electrical Stimulation of the Genioglossus on Upper Airway Resistance in Anesthetized Dogs

Miki, Hiroshi; Hida, Wataru; Shindoh, Chiyohiko; Kikuchi, Yoshihiro; Chonan, Tatsuya; Taguchi, Osamu; Inoue, Hiroshi; Takishima, Tamotsu

doi:10.1164/ajrccm/140.5.1279

Cited by 72 publications

(40 citation statements)

References 13 publications

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“…In anesthetized dogs and rabbits, these studies confirmed uniformly that UAW muscle con traction reduces Ruaw [7][8][9] and stabilizes the UAW against collapse [9][10][11]. In cats, however, both direct ES of the geniohyoid and HGN ES failed to reduce Ruaw [13.…”

Section: Hypoglossus Nerve Stimulationmentioning

confidence: 79%

Improved Upper Airway Patency Elicited by Electrical Stimulation of the Hypoglossus Nerves

Oliven

Odeh

Rp³

1996

Respiration

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The present study evaluated the mechanisms by which upper airway (UAW)- dilating muscle contraction, elicited by hypoglossus nerve (HGN) stimulation, improved UAW patency. Pressure-flow (P-V) relationships of the isolated UAW as well as the negative intraluminal pressures required to cause UAW collapse were assessed before and during electrical stimulation of the HGN in 8 anesthetized, ventilated dogs. Sectioning of the HGN shifted the P-V relationship to the left, while electrical stimulation resulted in a substantial shift of the curve to the right, indicating UAW dilatation. UAW resistance decreased from9.0 ± 1.5to0.3 ± 0.1 cm H₂O • 1^-1·s during HGN stimulation (p < 0.01). The magnitude of negative intraluminal pressure at which UAW collapse occurred (the critical pressure) increased from -2.7 ± 0.7 to -13.2 ± 2.1 cm H₂O (p < 0.002). The increase in UAW conductance and stability raised the maximal flow which could be sustained without collapse from 0.28 ± 0.07 to 2.07 ± 0.35 l/s during HGN stimulation (p < 0.001). These findings indicate that in the anesthetized dog, UAW muscle contraction improves UAW patency both by dilating the UAW and by stiffening its walls.

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Section: Hypoglossus Nerve Stimulationmentioning

confidence: 79%

Improved Upper Airway Patency Elicited by Electrical Stimulation of the Hypoglossus Nerves

Oliven

Odeh

Rp³

1996

Respiration

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“…Considering the obvious role of neuromuscular mechanisms in the pathogenesis of OSA, since apnoeas occur only during sleep in association with a decline in GG activity [38], it is reasonable to assume that adequately applied electrical activation of this muscle may prevent pharyngeal collapse. Therefore, attempts to stimulate the GG in OSA patients for therapeutic purposes have been undertaken ever since the physiological importance of this muscles' action was appreciated, with variable results [2,36,39,40]. A major advance has been achieved recently when a group of OSA patients were implanted with chronic hypoglossus nerve stimulators, using cuff or sleeve-like electrodes implanted unilaterally around a hypoglossus nerve, with stimulation triggered by inspiration [3,41].…”

Section: Sleep-related Disorders Y Dotan Et Almentioning

confidence: 99%

“…The obvious need for new treatment modalities is directed towards two lines of approach: anatomic (such as surgical procedures) and functional, i.e. electrical stimulation of the upper airway dilator muscles [2,3]. The genioglossus (GG) muscle, which is the main tongue protrusor, has been shown to reduce pharyngeal resistance and collapsibility by far more than other upper airway dilator muscles [4,5], and has become, therefore, the main target for functional stimulation for therapeutic purposes [2,3].…”

mentioning

confidence: 99%

Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea

Dotan¹,

Golibroda²,

Oliven³

et al. 2010

Eur Respir J

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Chronic stimulation of the hypoglossus nerve may provide a new treatment modality for obstructive sleep apnoea (OSA). In previous studies we observed large differences in response to stimulation of the genioglossus (GG). We hypothesised that both individual patient characteristics and the area of the GG stimulated are responsible for these differences.In the present study, we compared the response to GG electrical stimulation at the anterior area (GGa-ES), which activates the whole GG and the posterior area (GGp-ES), which activates preferentially the longitudinal fibres. Studies were performed in 14 propofol-sedated OSA patients. The parameters evaluated included cephalometry, pressure-flow relationship and pharyngeal shape and compliance assessed by pharyngoscopy.Compared with GGa-ES, GGp-ES resulted in significantly larger decreases in the critical value of end-expiratory pressure (Pcrit) (from 3.8¡2.2 to 2.9¡3.3 and -2.0¡3.9 cmH 2 O, respectively (p,0.001)). Both tongue size and velopharyngeal shape (anteroposterior to lateral ratio) correlated significantly with the decrease in Pcrit during respectively; p,0.05). In the patients with the larger tongue size (n57), the decrease in Pcrit reached 8.0¡2.2 cmH 2 O during GGp-ES.We conclude that directing stimulation to longitudinal fibres of the GG improves the flowmechanical effect. In addition, patients with large tongues and narrow pharynx tend to respond better to GGp-ES.

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“…Electrical Stimulation for OSA Electrical stimulation of the hypoglossal nerve was first investigated in animal studies [80,81] to evaluate the role of the genioglossus muscle and the principal dilator muscle in maintaining upper airway patency during sleep. This review focuses on the results from the first chronic human study [82] using an implanted stimulation system (the Inspire I ™ system, Medtronic, Inc., USA).…”

Section: Oral Appliancesmentioning

confidence: 99%

Cardiovascular Implications in the Treatment of Obstructive Sleep Apnea

Vanderveken

Boudewyns

et al. 2010

J. of Cardiovasc. Trans. Res.

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Epidemiological studies provide strong evidence that obstructive sleep apnea (OSA) is associated with cardiovascular complications such as systemic hypertension, congestive heart failure, and atrial fibrillation. Successful OSA treatment with continuous positive airway pressure (CPAP) has resulted in coincident reductions in systemic hypertension, improvements in left ventricular systolic function, and reductions in sympathetic nervous activity. These data suggest that successful treatment of OSA may reduce cardiovascular morbidity in such patients. Although CPAP is the more successful treatment for OSA when used properly and consistently, its clinical success is often limited by poor patient and partner acceptance, which leads to suboptimal compliance. Oral appliances or upper airway surgeries are considered a second line of treatment for patients with mild to moderate OSA who do not comply with or refuse long-term CPAP treatment. Oral devices such as mandibular repositioning appliances were recently shown to improve arterial hypertension in OSA patients. Electrical stimulation of the hypoglossal nerve is a new investigational therapy for patients with moderate to severe OSA. This new treatment option, if proven effective, may provide cardiovascular benefits secondary to treating OSA.

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Effects of Electrical Stimulation of the Genioglossus on Upper Airway Resistance in Anesthetized Dogs

Cited by 72 publications

References 13 publications

Improved Upper Airway Patency Elicited by Electrical Stimulation of the Hypoglossus Nerves

Improved Upper Airway Patency Elicited by Electrical Stimulation of the Hypoglossus Nerves

Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea

Cardiovascular Implications in the Treatment of Obstructive Sleep Apnea

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