Inclusion of the first cervical nerve does not influence outcomes in upper airway stimulation for treatment of obstructive sleep apnea

Abstract

Objectives/Hypothesis: Upper airway stimulation (UAS) has demonstrated efficacy in the management of obstructive sleep apnea (OSA). Branches of the hypoglossal nerve that selectively activate tongue protrusor and stiffener muscles are included within the stimulation cuff electrode. The first cervical nerve (C1) is often also included to stimulate additional muscles contributing to tongue protrusion and stabilization. The purpose of this study was to determine whether inclusion of the C1 translates into treatment efficacy, decreased voltage requirement, and improved outcomes in patients utilizing UAS.Study Design: Single-center, retrospective cohort study. Methods: One hundred fourteen patients who received a UAS implant at our institution and underwent posttreatment polysomnography were evaluated. Stimulation cuff electrodes in 87 patients included the C1; those in the remaining 27 patients did not include the C1. Demographic data, voltage data, and pre-and posttreatment apnea-hypopnea index (AHI), O 2 nadir, and Epworth Sleepiness Scale (ESS) data were collected for all patients.Results: There was no significant difference in stimulation voltage, or posttreatment AHI, O 2 nadir, and ESS between the two cohorts. Treatment success, as measured by posttreatment AHI < 20 with a 50% reduction, was similar regardless of C1 inclusion. The same was seen for the percent of patients with AHI < 15 and AHI < 5 after treatment. The distributions of age and body mass index, as well as pre-treatment AHI, O 2 nadir, and ESS were also not significantly different between treatment groups.Conclusions: The current study has demonstrated that inclusion of the C1 in the stimulation cuff electrode of the upper airway stimulator may not provide any additional benefit in therapy for OSA.Key Words: Sleep medicine, obstructive sleep apnea, surgical treatment of obstructive sleep apnea, quality of life.

Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea

“…A bi-polar stimulator is utilized to identify and assist in separation of these branches. In addition, it is typical that the first cervical nerve branch to the geniohyoid muscle is included in the dissection and ultimately within the stimulation electrode; however, recent data suggest that this may not assist in any additional reductions in sleep apnea postoperatively [27]. Once the nerve branches to the protrusors are identified, the stimulation electrode is wrapped around the branches, and the electrode cuff is held in place via friction and an anchoring site sutured to the digastric tendon.…”

Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea

“…3). While recommended for inclusion, it has not yet shown additional benefit in OSA treatment [49]. A radiologic study revealed that smaller baseline soft palate volume and greater anterior tongue movement with stimulation improved treatment response to UAS [50].…”