Hypoglossal nerve stimulation over-titration

Melisa Chang; Virginia Moore; Kevin Eng; Armand Ryden; Michelle Zeidler

doi:10.5664/jcsm.11066

Hypoglossal nerve stimulation over-titration

J Clin Sleep Med. 2024 Feb 28. doi: 10.5664/jcsm.11066. Online ahead of print.

Authors

Melisa Chang^{1

2}, Virginia Moore¹, Kevin Eng^{1

2}, Armand Ryden^{1

2}, Michelle Zeidler^{1

2}

Affiliations

¹ Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Greater Los Angeles Healthcare System.
² David Geffen School of Medicine at UCLA, Division of Pulmonary, Critical Care & Sleep Medicine.

PMID: 38415706
DOI: 10.5664/jcsm.11066

Abstract

This case report reviews worsening obstructive sleep apnea (OSA) events in a patient over-titrated with a hypoglossal nerve stimulator (HNS). A healthy 57-year-old man underwent HNS implantation for moderate OSA. During an in- laboratory HNS titration the patient had improvement of his OSA at 2.1V. However further increase of voltage resulted in worsening of obstructive events. The pathophysiology behind this finding is unknown but may result from unfavorable changes in the upper anatomy due to higher energy delivered to the hypoglossal nerve and surrounding structures. This high energy may also lead to genioglossus muscle fatigue. This finding highlights the importance of hypoglossal nerve stimulation titration with a dedicated sleep study.

Keywords: CPAP intolerance; airway anatomy; hypoglossal nerve stimulation; obstructive sleep apnea; over-titration.

Publication types

Case Reports