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Palatoglossus coupling in selective upper airway stimulation.
Clemens Heiser1, Günther Edenharter2, Murat Bas1
1Department of Otorhinolaryngology-Head and Neck Surgery, Technical University of Munich, Munich, Germany.
The Laryngoscope
|January 21, 2017
Summary
Selective upper airway stimulation (sUAS) effectively treats obstructive sleep apnea by improving retropalatal opening. Bilateral tongue base protrusion during sUAS correlates with better soft palate opening, suggesting palatoglossal coupling plays a key role.
Area of Science:
- Otorhinolaryngology
- Sleep Medicine
- Neuromodulation
Background:
- Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep.
- Selective upper airway stimulation (sUAS) of the hypoglossal nerve offers a therapeutic option for OSA patients, targeting various obstruction sites, including the retropalatal region.
- The precise mechanism by which sUAS achieves retropalatal opening, particularly concerning soft palate dynamics, requires further elucidation.
Purpose of the Study:
- To investigate the effect of selective upper airway stimulation (sUAS) on palatoglossus muscle activity and soft palate coupling in patients with obstructive sleep apnea.
- To determine if specific tongue base movements during sUAS correlate with improved retropalatal airway dimensions.
Main Methods:
- A prospective clinical trial involving 20 patients implanted with an sUAS device.
- Drug-induced sedated endoscopy (DISE) was performed pre- and post-stimulation.
- Tongue motion analysis and awake transnasal endoscopy with stimulation were conducted 6-12 months post-activation.
Main Results:
- Patients exhibiting bilateral tongue base protrusion during sUAS demonstrated significantly greater retropalatal opening compared to those with ipsilateral protrusions.
- Clear activation of the geniohyoid muscle was associated with a more substantial reduction in the apnea-hypopnea index (AHI).
Conclusions:
- Bilateral tongue base protrusion during sUAS appears to enhance soft palate opening, likely mediated by palatoglossal coupling.
- This coupling mechanism links the soft palate muscles to the lateral tongue muscles, contributing to airway patency during stimulation.
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