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CPAP alternative? Implantable neurostimulator reduced apnea severity

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Hypoglossal nerve stimulation appears effective

The findings by Strollo et al. give clinicians the rationale to consider hypoglossal nerve stimulation for selected patients who have trouble with CPAP therapy, said Dr. Atul Malhotra.

Given the pathophysiology of obstructive sleep apnea, a substantial proportion of patients would probably benefit from this treatment, even though symptoms were only reduced rather than completely eradicated. "Although the elimination of apnea would clearly be desirable, the observed reductions are probably similar to the benefits observed with CPAP, particularly when one considers the variability of adherence to CPAP therapy," he said.

Dr. Atul Malhotra is in the division of pulmonary and critical care medicine at the University of California, San Diego. He reported previous ties to Philips Respironics, Apnex, and Apnicure. These remarks were taken from his editorial accompanying Dr. Strollo’s report (N. Engl. J. Med. 2014 [doi:10.1056/NEJMe1314084]).


 

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

Twenty-three patients experienced temporary tongue weakness after the surgery, which resolved in all of them. Nine patients began using a tooth guard to resolve tongue soreness or abrasion.

"This approach may not be appropriate for persons with excessive airway collapsibility," Dr. Strollo and his associates cautioned. They screened potential study participants using endoscopy during drug-induced sleep, to identify functional upper-airway collapse originating in the retrolingual region, which would be the most amenable to neurostimulation at the base of the tongue.

The FDA’s Anesthesiology and Respiratory Therapy Devices Panel of the Medical Devices Advisory Committee will discuss, make recommendations, and vote on information related to the premarket approval application on Feb. 20.

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