Elektrische Atemwegsstimulation zur Therapie der obstruktiven Schlafapnoe

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of pharyngeal collapse resulting from a decrease in tone of the dilatory musculature of the pharynx. Electrical stimulation of the hypoglossal nerve is a new clinical treatment modality for patients with moderate to severe OSA, who do not respond to standard therapy with continuous (CPAP) or automatically adjusted (APAP) positive airway pressure therapy or adjustable mandibular advancement devices. After decades of trials demonstrating proof of concept of hypoglossal nerve stimulation (HNS), the results of the large STAR multicenter prospective trial using the Inspire? device were recently published. The results show that HNS can prevent pharyngeal collapse without arousing patients from sleep and HNS with the Inspire? device led to a significant improvement of objective and subjective measurements of the severity of OSA. A limitation of available HNS remains the invasive procedure and the costs involved. Further research is required to define optimal patient selection and device performance and to investigate long-term effectiveness. The absence of a complete circular collapse at the level of the palate as documented during drug-induced sleep endoscopy can predict success with implanted HNS therapy and is therefore a requirement for the implantation of the Inspire? device, which is rarely effective in cases with complete concentric collapse at the level of the soft palate. It is strongly recommended that implantation of HNS devices is performed only in experienced centers with multidisciplinary sleep medicine teams. The recruitment of patients in clinical trials and enrollment in registries could help to control quality and costs.