Hypoglossal Nerve Stimulation (HGNS) is an advanced treatment for Obstructive Sleep Apnea (OSA), which comprises a surgically implanted device that sends signals to the nerve -of the tongue (hypoglossal nerve), to prevent the tongue from blocking the upper airway during sleep. OSA is a condition where the muscles at the back of your throat relax too much during sleep, causing your airway to collapse. This leads to pauses in breathing, snoring, and poor sleep quality. Unlike traditional therapies like CPAP (Continuous Positive Airway Pressure) that require wearing a mask, HGNS is a small, implantable device that works from inside your body to keep your airway open. It can be useful for patients who struggle with using the CPAP daily.
Inspire Sleep Therapy is one of the first hypoglossal nerve stimulation systems approved by the U.S. Food and Drug Administration, which has been proven to be safe and effective in multiple clinical studies. This therapy can be considered for patients with moderate to severe OSA - in particular, patients who have struggled with other treatments such as CPAP therapy, dental appliances, or others. This therapy comprises a surgically implanted device that monitors breathing patterns and provides electrical stimulation/signals to the tongue nerve. This tongue nerve stimulation moves the tongue forward and keeps the airway open.
The device stimulates the hypoglossal nerve, which controls the muscles of your tongue, moving your tongue and palate forward to prevent it from blocking your airway. Patients undergoing Inspire Sleep Therapy turn on a remote before they go to sleep, with the device being programmed to start stimulation later (about 30 - 45 mins later) to allow time for patients to fall asleep before starting the stimulation. The device can also be paused and restarted if the patient needs to wake up in the middle of the night. HGNS works automatically, adjusting to the patient’s breathing patterns, allowing for uninterrupted, restful sleep without external equipment like masks or hoses.
Remote control for Inspire Sleep Therapy: Allows patients to turn on the device when going to bed, or pause and start therapy when they go to the toilet
HGNS has been shown to be a highly effective treatment for moderate to severe OSA. Clinical trials and ongoing studies reveal significant benefits, including:
In patient satisfaction surveys, over 85% of users are happy with the results and would recommend the treatment to others. This therapy has been particularly beneficial for individuals who cannot tolerate CPAP therapy.
Undergoing the Surgery Pre-surgical Evaluation: Before surgery, you’ll undergo a sleep study to confirm the severity of your OSA. You will also need a drug-induced sleep endoscopy (DISE) which is a day surgery procedure to evaluate your upper airway anatomy to ensure that HGNS is the right treatment for you.
Surgical Procedure: On the day of surgery, under general anaesthesia, the device components are implanted. The pulse generator is placed under your skin in the chest area, the breathing sensor near your ribs, and the stimulation lead is connected to the hypoglossal nerve in your neck.
Recovery and Healing: Generally, this surgery is not painful. You may experience mild discomfort at the incision sites, which is usually managed with over-the-counter pain medication such as paracetamol. You will be advised to avoid large movements or any strenuous exercises on the side of the implant (usually the right arm, right chest) for about 4 -6 weeks after surgery. Your doctor will usually review your wound 7 -10 days after surgery.
Device Activation and Programming: About a month after the surgery, the device will usually be activated during a follow-up visit if your wound and recovery is optimal. Your doctor will fine-tune the settings to match your breathing patterns. You’ll receive a handheld remote control that allows you to turn the device on before bed and off when you wake up.
Ongoing Monitoring: After activation, your doctor will monitor your progress over several months to ensure the device is working optimally. A repeat sleep study is usually done to fine-tune your device setting to allow for an optimal, comfortable setting which is therapeutic. Regular follow-ups are usually scheduled annually to check the device and adjust the settings if needed.
The HGNS device is implanted during a minimally invasive outpatient surgery, typically lasting 2 to 3 hours. The surgery is performed under general anaesthesia to ensure patients are comfortable throughout the procedure. Here are the key steps of the procedure:
After surgery, patients are typically discharged the same day or after a short hospital stay, depending on your doctor’s recommendation.
Pulse Generator Placement
While HGNS is considered safe with overall risks less than 1% based on published data, there are some potential risks and side effects associated with the surgery and the device itself.
Your healthcare team will go through the side effects and complications of this surgery in more detail and guide you through it. Making appropriate adjustments can often improve your comfort and functionality.
Hypoglossal Nerve Stimulation Implant therapy is generally recommended for adults with moderate to severe OSA who:
HGNS is not suitable for patients with severe neuromuscular disorders, allergies to device materials, or those with untreated, severe cardiac conditions. A thorough evaluation with your sleep specialist will determine if you are a good candidate.
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By understanding Hypoglossal Nerve Stimulation and its benefits, risks, and the procedure, you can make an informed decision. Speak with your doctor if you think HGNS could be the right solution to help you regain restful sleep and improve your quality of life.
The Department of Otorhinolaryngology – Head & Neck Surgery at Sengkang General Hospital provides a wide range of specialist services focusing on a wide range of ear, nose, throat, sleep apnoea, and head and neck cancer conditions.
The Sleep Medicine Unit at Sengkang General Hospital is a multidisciplinary sleep team helmed by Ear, Nose and Throat (ENT) surgeons, respiratory physicians, orthodontists, psychiatrists, psychologists and sleep technologists specialising in the diagnosis and management of a wide range of sleep disorders like obstructive sleep apnoea, snoring, insomnia, obesity hypoventilation syndrome, circadian rhythm sleep disorders, narcolepsy, parasomnias, and other sleep related movement disorders.
For appointments, contact us at 6930 6000 or email us at [email protected].
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