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Perioperative and Perianesthesia Considerations for Hypoglossal Nerve Stimulator Implantation in Obstructive Sleep Apnea Patients

      ABSTRACT

      Hypoglossal nerve stimulation (Inspire Medical Systems, Maple Grove, Minnesota) is an innovative treatment option for eligible patients with moderate to severe obstructive sleep apnea (OSA). Since U.S. Food and Drug Administration approval in 2014, over 18,000 patients have been implanted. The device includes an implanted pacemaker-sized pulse generator, one sensing lead, and one stimulation lead. During sleep, inspirations and expirations are detected by the sensing lead. At end expiration, the stimulation lead triggers the hypoglossal nerve to contract and stiffen the tongue thus preventing airway obstruction and improving OSA. Perioperative and perianesthesia nurses have an important role in caring for these patients during all aspects of the surgical insertion process: evaluation for eligibility, device implantation, and future visits to the perioperative area for related and unrelated procedures. This article reviews anatomic and physiologic factors contributing to airway collapse in OSA, function of the hypoglossal nerve stimulation device, the evaluation, implantation, and activation process, and considerations for patient care in the perioperative and perianesthesia periods. Precautions needed for other therapies, including Magnetic Resonance Imaging, diathermy, and radiation are also discussed.

      Keywords

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      References

        • Gupta RJ
        • Kademani D
        • Yung-Chuan S.
        Upper airway (Hypoglossal nerve) stimulation for treatment of obstructive sleep apnea.
        Atlas Oral Maxillofacial Surg Clin N Am. 2019; 27: 53-58
        • Hassan F
        • Kaplish N.
        Hypoglossal nerve stimulator: A novel treatment approach for OSA- Overview of treatment, including diagnostic and patient criteria and procedural terminology codes.
        Chest. 2021; 160: 1406-1412
        • Olson MD
        • Junna MR.
        Hypoglossal nerve stimulation therapy for the treatment of obstructive sleep apnea.
        Neurotherapeutics. 2021; 18: 91-99
        • Soose RJ.
        Novel surgical approaches for the treatment of obstructive sleep apnea.
        Sleep Med Clin. 2016; 11: 189-202
        • Maresch K.
        Hypoglossal nerve stimulation: Effective long-term therapy for obstructive sleep apnea.
        AANA J. 2018; 86: 412-416
        • Tishler PV
        • Larkin EK
        • Schluchter MD
        • Redline SM.
        Incidence of sleep-disordered breathing in an urban adult population.
        JAMA. 2003; 289: 2230-2237
        • Lee W
        • Nagubadi S
        • Kryger MH
        • Mokhlesi B.
        Epidemiology of obstructive sleep apnea: A population based perspective.
        Expert Rev Respir Med. 2008; 2: 349-364
        • Gottleib J
        • Punjabi N.
        Diagnosis and management of obstructive sleep apnea: A review.
        JAMA. 2020; 323: 1389-1400
        • Rundo J.
        Obstructive sleep apnea basics.
        Cleve Clin J Med. 2019; 86: 2-9
        • Sher AE
        • Schechtman KB
        • Piccirillo JF.
        The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.
        Sleep. 1996; 19: 156-177
        • White DP.
        Pathogenesis of obstructive and central sleep apnea.
        Am J Respir Crit Care Med. 2005; 172: 1363-1370
        • Mezzanotte WS
        • Tangel DJ
        • White DP.
        Waking genioglossus electromyelogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism).
        J Clin Investig. 1992; 89: 1571-1579
        • Dedhia RC
        • Strollo PJ
        • Soose RJ.
        Upper airway stimulation for obstructive sleep apnea: Past, present, and future.
        Sleep. 2015; 38: 899-906
        • Kezirian EJ
        • Hohenhorst W
        • deVries N.
        Drug-induced sleep endoscopy: The VOTE classification.
        Eur Arch Otorhinolaryngol. 2011; 268: 1233-1236
        • Vanderveken OM
        • Maurer JT
        • Hohenhorst W
        • et al.
        Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea.
        J Clin Sleep Med. 2013; 9: 433-438
        • Safiruddin F
        • Vanderveken O
        • de Vries N
        • et al.
        Effect of upper-airway stimulation for obstructive sleep apnea on airway dimensions.
        Eur Resp J. 2015; 45: 129-138
        • You A
        • Kang H
        • Kim Y.
        The 95% effective target concentration of propofol for drug-induced sleep endoscopy in males with obstructive sleep apnea.
        J Clin Anesth. 2021; 72110312
      1. System Implant Manual. (2021). In Inspire Sleep https://manuals.inspiresleep.com

      2. Inspire Patient Manual. (2021). In Inspire Sleep.https://manuals.inspiresleep.com

        • Vasconcellos A
        • Huntley C
        • Schell A
        • Soose R
        • Boon M.
        Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series.
        Laryngoscope. 2019; 129: 1949-1953
      3. MRI Guidelines for Inspire Therapy. (2021). In Inspire Sleep.https://manuals.inspiresleep.com