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Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea

¹Department of Medicine B, Bnai-Zion Medical Center, Technion, Haifa 31048, Israel; ²Johns Hopkins Sleep Disorders Center, ³Johns Hopkins Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205; ⁴Medtronic, Minneapolis, Minnesota 55432; and ⁵University Hospital, B-2650 Antwerp, Belgium

Submitted 28 February 2003 ; accepted in final form 10 June 2003

Contraction of the genioglossus (GG) has been shown to improve upper airway patency. In the present study, we evaluated responses in upper airway pressure-flow relationships during sleep to electrical stimulation (ES) of the GG in patients with obstructive sleep apnea. Five patients with chronically implanted hypoglossal nerve (HG) electrodes and nine patients with fine-wire electrodes inserted into the GG were studied. Airflow was measured at multiple levels of nasal pressure, and upper airway collapsibility was defined by the nasal pressure below which airflow ceased ["critical" pressure (Pcrit)]. ES shifted the pressure-flow relationships toward higher flow levels in all patients over the entire range of nasal pressure applied. Pcrit decreased similarly during both HG-ES and GG-ES (Pcrit was 3.98 ± 2.31 and 3.18 ± 1.70 cmH₂O, respectively) without a significant change in upstream resistance. The site of collapse (velo- vs. oropharynx) did not influence the response to GG-ES. Moreover, ES-induced reductions in the apnea-hypopnea index of the HG-ES patients were associated with substantial decreases in Pcrit. Our findings imply that responses in apnea severity to HG-ES can be predicted by characterizing the patient's baseline pressure-flow relationships and response to GG-ES.

hypoglossus; critical pressure; pressure-flow relationships

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