Hypoglossal nerve stimulation as therapy for obstructive sleep apnea in a patient with CPAP-intolerance after radiochemotherapy

Introduction 

Patients who have undergone head and neck radiotherapy often suffer from postrdaiogenic xerostomia, which is a risk for intolerance of CPAP therapy for patients suffering from obstructive sleep apnea (OSA). We report a male 59-year-old patient who underwent radiochemotherapy for cT1cN1cM0 nasopharyngeal carcinoma 12 years previously an who suffered from severe OSA. The ESS score was 17/24 points, BMI was 31kg/m². CPAP attempts remained frustrated despite mucosal humidification.

Methods 

DISE (drug induced sleep endoscopy) showed complete anterior-posterior collapse at velum, tongue base and epiglottis level without tonsillar collapse. The mucosa was postradiogenically altered. We indicated the implantation of a hypoglossal nerve stimulator.

Results 

The operative and postoperative course remained without complications. The implant could be activated 4 weeks postoperatively and showed bilateral functional protrusion at 1.0V with bipolar electrode configuration.Polysomnography under stimulation therapy 3 months after implantation showed a reduction in AHI to 9/h. The ESS score was reduced to 8/24 points. Follow-up at 6, 12, and 24 months showed consistent sufficient therapy without complications.

Discussion 

For patients who have undergone head and neck radiationand suffer from sleep apnea, xerostomia may be a reason for CPAP intolerance. These patients may represent a suitable patient population for therapy with a tongue pacemaker.

Publication History

Article published online:
24 May 2022