Stimulation for a good night’s sleep
Reviewed by Suzanne Jervis

This article was an interesting read. It is an update from the authors’ original paper printed in the NEJM in 2014 regarding the results of an implantable pulse generator (IPG) for stimulating the hypoglossal nerve in response to respiration. This device is implanted under the right clavicle with electrodes that sense respiration and then stimulate the hypoglossal nerve to increase tone and activity within the tongue bulk and reduce airway collapse. The device is programmable with a physician interface but also modifiable with a patient interface. This also enables them to turn the device on and off and select the desired signal intensity. The article principally highlights the surgical modifications to the insertion technique since their original publication in an attempt to further select the portion of the nerve that innervates the protruders of the tongue, rather than the retractors. The authors stress that further long-term data is required regarding the safety of the device, but initial 12-18 month safety data is encouraging, alongside the data regarding the device’s efficacy. For a reader who had not previously read their original article, some information regarding its efficacy would have been welcome, but one does suspect that it is highly dependent on a specially selected population. Nonetheless, further research on a seemingly successful device with minimum risk for hypopharyngeal OSA is welcome in the realm of surgical techniques that are a long way from perfection. 

Upper airway stimulation for obstructive sleep apnea.
de Vries N, Maurer JT.
OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY – HEAD AND NECK SURGERY 2015:26(4);216-20.