Complexe sleep apnea as a challenge for hypoglossal nerve stimulation

Introduction:

A 52 year old male patient was referred to our hospital with persistent daytime sleepiness. An external sleep laboratory had diagnosed obstructive sleep apnea and used continuous positive airway pressure as first-line therapy. The patient has a family history of cardial disease and therefore a strong motiviation for therapy.

Methods:

We changed to automatic positive airway pressure therapy in addition to a vest to prevent supine position. However, daytime sleepiness increased, although the patient showed a very good compliance. A polygraphy showed a very strong increase of central apnea. In consequence we changed to adaptive servoventilation therapy which was able to control the respiratory events very well. Eventhough we optimized the therapy multiple times daytime sleepiness increased. Finally, we agreed with the patient to pause therapy. After the pause we could again only detect obstructive sleep apnea. Mask intolerance as well as intolerance to ventilation therapy lead us to hypoglossal nerve stimulation as an individual therapeutical approach.

Results:

The patient underwent hypoglossal nerve surgery with an intercostal sensory lead without complications. After activation daytime sleepiness ceased. Titration of stimulation was prolonged with still some central apnea left.

Conclusions:

Hypoglossal nerve stimulation can be considered as an individual therapeutical approach when facing the challenging problem of complexe sleep apnea.

Publication History

Publication Date:
23 April 2019 (online)