Position Statement: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (OSA)

The American Academy of Otolaryngology-Head and Neck Surgery considers upper airway stimulation (UAS) via the hypoglossal nerve for the treatment of adult obstructive sleep apnea syndrome to be a safe and effective second-line treatment of moderate to severe obstructive sleep apnea in patients who are intolerant or unable to achieve benefit with positive pressure therapy.

Submitted for Review 10/2014
Resubmitted for Review 11/30/2015
Resubmitted for Review 1/4/2016
Revised 3/20/2016
Revised 11/13/2019

References: 

1. Lurie A: Obstructive Sleep Apnea in Adults. Adv Cardiol. Basel, Karger, 2011, vol 46, pp 1–42. doi: 10.1159/000327660
2. Leung RST, Bradley TD. Sleep Apnea and Cardiovascular Disease. Am. J. Respir. Crit. Care Med. 2001; 164:2147-65.
3. Keenan SP, Burt H, Ryan CF, Fleetham JA. Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest 1994; 105:155-9.
4. He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988; 94:9-14.
5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342:1378-84.
6. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased Incidence of Cardiovascular Disease in Middle-aged Men with Obstructive Sleep Apnea: A 7-Year Follow-up. Am. J. Respir. Crit. Care Med. 2002; 166:159-65.
7. Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population- based sample of employed adults. Sleep 1997; 20:608-13.
8. Rotenberg BW, Murariu D, Pang KP.  Trends in CPAP adherence over twenty years of data collection: a flattened curved.Journal of Otolaryngology – Head & Neck Surgery 2016 45:43
9. Safiruddin F, Vanderveken OM, de Vries N, Maurer JT, Lee K, Ni Q, et al. Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions. Eur Respir J. 2015;45(1):129–138. doi: 10.1183/09031936.00059414.
10. Goding GS, Jr, Tesfayesus W, Kezirian EJ. Hypoglossal nerve stimulation and airway changes under fluoroscopy. Otolaryngol Head Neck Surg. 2012;146(6):1017–1022. doi: 10.1177/0194599812436472.[
11. Strollo PJ, Soose RJ, Maurer JT et al. Upper-Airway Stimulation for Obstructive Sleep Apnea.  N Engl J Med 2014; 370:139-49
12. Kent DT, Lee JJ, Strollo PJ, and Soose RJ.  Upper Airway Stimulation for OSA: Early Adherence and Outcome Results of One Center. Otolaryngology-Head and Neck Surgery 2016, Jul; 155(1):188-193
13. Mahmoud AF, Thaler ER. Upper Airway Stimulation Therapy and Prior Airway Surgery for Obstructive Sleep Apnea. Laryngoscope.  2017 Oct 31
14. Huntley C, Kaffenberger T, Doghramji K et al. Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: An Evaluation and Comparison of Outcomes at Two Academic Centers. Journal of Clinical Sleep Medicine. 2017; 13(9): 1075-1079
15. Woodson BT, Soose RJ, Gillespie MB et al. Three-Year Outcomes of Crainial Nerve Stimulation for Obstructive Sleep Apnea: The STAR Trial.  Otolaryngology-Head and Neck Surgery 2016, Vol 154(1): 181-188
16. Dedhia RC, Strollo PJ, Soose RJ. Upper airway stimulation for obstructive sleep apnea: past, present, and future. Sleep. 2015;38(6):899–906.

Important Disclaimer Notice (updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.