Optimizing therapy in bilateral hypoglossal nerve stimulation: individual programming strategies for synchronizing stimulation and breathing

Introduction Synchronization of stimulation and respiration is an important component for optimizing therapy using selective hypoglossal nerve stimulation (HGNS). While this is done by an intercostal pressure sensor in unilateral selective HGNS, synchronization in bilateral HGNS is done by individual programming of stimulation length and frequency (duty cycle, DC). Therefore, the hypothesis that an increase in duty cycle could lead to an increased hit rate during the inspiration phase and increased inspiratory airflow was investigated.

Material and methods Analysis of respiratory flow in a titration polysomnography was performed in five patients who had been fitted with a system for bilateral HGNS (GenioTM System). The effects of changes in DC and stimulation length, with all other parameters remaining constant, were investigated over segments of at least 100 breaths in identical body positions.

Results Mean duration of analyzed segments was 21±12.3 minutes. Mean breathing frequency was 10.8-18.6 breaths per minute. Lower duty cycles ranged from 50-62% and stimulation length from 1.0-4.0 seconds, higher DC from 60-75% and stimulation length from 1.5-4.4 seconds. Average overlap of stimulation and inspiration was increased by the changed settings from 58±6% to 82±12% with an increased averaged depth of inspiratory airflow.

Conclusion Effectiveness of bilateral hypoglossal nerve stimulation can be increased by individual titration and changes in parameters of stimulation as duty cycle, which are leading to a better overlap of stimulation and breathing and therefore an increased inspiratory airflow.

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Artikel online veröffentlicht:
12. Mai 2023