Combination Therapy of Hypoglossal Nerve Stimulation and OAT-Combination Therapy of Hypoglossal Nerve Stimulation and OAT Recording

Video Transcription

Video Summary

This presentation compared hypoglossal nerve stimulation (HNS) and mandibular advancement device (MAD) therapies for obstructive sleep apnea (OSA), focusing on their mechanisms, targets in the airway, patient selection, and outcomes. HNS electrically stimulates tongue muscles to protrude and stiffen the tongue, mainly addressing tongue base collapse, and has devices like Inspire, Nioxa, and Levonova with varying designs. MADs are custom oral appliances advancing the lower jaw to stabilize the airway, effectively reducing lateral wall and soft palate collapse, typically used in mild to moderate OSA. Drug-induced sleep endoscopy (DISE) helps identify airway collapse patterns critical for tailoring treatment and predicting success.<br /><br />Efficacy varies: HNS shows about 20-point reduction in apnea-hypopnea index (AHI), primarily beneficial for tongue base collapse but less so for concentric or lateral soft palate collapse; about 31% non-responders exist. MADs reduce AHI by about 10 points on average, best for lateral pharyngeal collapse, and effectiveness depends on custom, titratable designs. Combination therapy leverages complementary mechanisms—HNS targeting tongue base and MAD addressing velopharyngeal collapse—showing improved outcomes in complex or refractory cases. Early phenotyping and multimodal approaches, rather than severity-based therapy alone, are advocated to optimize patient outcomes. Case studies demonstrated significant improvements by combining HNS and MAD, emphasizing personalized, anatomy-driven treatment strategies.

Keywords

hypoglossal nerve stimulation

mandibular advancement device

obstructive sleep apnea

airway collapse

drug-induced sleep endoscopy

apnea-hypopnea index reduction

tongue base collapse

velopharyngeal collapse

combination therapy