Uncomplicated, successful upper airway stimulation in Parkinson’s disease.

Introduction Hypoglossal nerve stimulators (HNS) are part of the standard repertoire in second-line therapy of PAP non-adherence in moderate to severe obstructive sleep apnea (OSA) at many centers. The recently published " Weißbuch Stimulationstherapie des N. hypoglossus" (version 1.0 dated 8/23/22) by the DGHNOKHC and DGSM lists "Neuromuscular Disease" among other contraindications. The proprietary (Inspire Medical Systems, Inc.) formulation states contraindications for patients "with any condition or procedure that has compromised neurological control of the upper airway." Here we present a case with Parkinson’s disease and sensory polyneuropathy.

Case description A 70-year-old patient presented with severe OSA (AHI: 63.7, proportion of centric/combined apneas < 25%), preadipose habitus (BMI: 25.7) increased daytime sleepiness (ESS 13/24), and PAP nonadherence (discontinuation and intolerance). Multiple mask attempts, mandibular advancement splint, and supine prevention therapy were not effective. The oropharynx appeared transorally wide, the tonsils small. In the sleep endoscopy a complete-concentric velopharyngeal collapse could be excluded. In addition to a current sleep laboratory workup with HNS recommendation, inpatient neurological workup and medication optimization of levopopa/benserazide and pramipexole as well as clonazepam for REM sleep behavior disorder were performed. HNS implantation was uncomplicated, as was activation. Outpatient follow-up polygraphy showed a normalized AHI and the patient was highly satisfied.

Conclusion Unilateral hypoglossal stimulation proves to be an effective and safe therapy option also in patients with Parkinson’s disease.

Publication History

Article published online:
12 May 2023