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

Combination Therapy of Hypoglossal Nerve Stimulation and OAT Slides

Pdf Summary

The 2025 American Academy of Dental Sleep Medicine presentation by Dr. Harmeet Chiang, DDS, MS, focuses on the use of Hypoglossal Nerve Stimulation (HGNS) and Oral Appliance Therapy (OAT) as treatments for obstructive sleep apnea (OSA). The presentation outlines objectives including identifying anatomical predictors of treatment success, evaluating clinical outcomes using evidence-based criteria, and discussing patient selection for combined therapy.<br /><br />OSA affects a substantial portion of the U.S. adult population, with a large number remaining undiagnosed or untreated. While Continuous Positive Airway Pressure (CPAP) remains a common treatment, alternatives like HGNS and OAT provide options for those intolerant of CPAP. HGNS involves electrical stimulation of the hypoglossal nerve to open the airway during sleep, with various systems available differing in stimulation approaches. OAT uses custom-fit mandibular advancement devices to reposition the jaw, enlarging the airway mainly at the velopharyngeal level.<br /><br />The efficacy of both treatments varies by patient characteristics and disease severity, with some non-responder rates reported (31% for HGNS, 30–52% for OAT). HGNS tends to be more effective for tongue base collapse and OAT for velopharyngeal lateral wall collapse. Their mechanisms of action differ: HGNS actively displaces and stiffens the tongue through nerve stimulation, whereas OAT passively advances the mandible to enlarge the airway.<br /><br />Several clinical cases demonstrate that combination therapy utilizing both HGNS and OAT can improve outcomes in patients with complex or severe OSA, achieving greater reductions in apnea-hypopnea index (AHI) than either therapy alone. Combination therapy may allow for lower stimulation amplitudes and mandibular advancement, improving tolerability and efficacy.<br /><br />The presentation emphasizes multidisciplinary care and careful patient selection based on anatomical and physiological factors to optimize treatment success. It highlights the need for further clinical guidelines on treatment sequencing and phenotyping for combination therapy. Overall, combining HGNS and OAT offers a promising multimodal approach for managing OSA resistant to single therapies.

Keywords

Hypoglossal Nerve Stimulation

Oral Appliance Therapy

Obstructive Sleep Apnea

CPAP Intolerance

Mandibular Advancement Devices

Tongue Base Collapse

Velopharyngeal Lateral Wall Collapse

Combination Therapy

Apnea-Hypopnea Index

Multidisciplinary Care