Hypoglossal Nerve Stimulation
A surgically implanted device (commonly known by the brand name Inspire) that provides mild electrical stimulation to the motor nerve controlling the tongue, preventing airway collapse without a mask or hose.
Mechanism of Action
The system consists of a small generator implanted in the chest (similar to a pacemaker), a sensing lead placed between the ribs to detect breathing effort, and a stimulation lead wrapped around the hypoglossal nerve (which controls tongue movement) in the neck.
When the patient inhales, the sensor detects the effort, and the generator sends a mild electrical pulse to the hypoglossal nerve. This causes the tongue to stiffen and protrude slightly forward, clearing the airway precisely when it is most vulnerable to collapse.
Indications & Eligibility
HNS is not a first-line therapy. It is strictly indicated for patients who meet all of the following criteria:
- Diagnosed with moderate to severe OSA (AHI of 15 to 65).
- Documented failure or intolerance to CPAP therapy.
- BMI generally under 32 (though some criteria allow up to 35).
- A drug-induced sleep endoscopy (DISE) confirming a specific pattern of airway collapse (absence of complete concentric collapse at the soft palate).
Surgical Risks & Limitations
- Infection at the implant site.
- Temporary weakness or soreness of the tongue.
- The device battery requires surgical replacement every 10-11 years.
- Limits compatibility with certain MRI machines (though newer models are conditionally safe).
Clinical Profile
- Primary Indication CPAP-Intolerant Mod/Severe OSA
- Efficacy Rate ~68% reduction in AHI
- Avg. Total Cost $30k - $40k (pre-insurance)
- Invasiveness Surgical