Tongue pacemaker

In the case of moderate to severe obstructive sleep apnoea (OSA) with breathing interruptions during sleep, positive pressure therapy using a breathing mask is the standard therapy (CPAP). However, this mask is not tolerated by all patients. In addition, there are occupational groups for which it is not possible to wear a mask at night for the minimum period required.  

Latest therapy method: the tongue pacemaker

In this case, the tongue pacemaker is a possible alternative. Hypoglossal stimulation is the latest treatment method for patients with obstructive sleep apnoea. The tongue pacemaker prevents the tongue from falling back into the throat and thus prevents breathing interruptions during sleep.

At Regensburg University Hospital, the sleep laboratory of the Clinic and Polyclinic for Internal Medicine II  and the Clinic and Polyclinic for Ear, Nose and Throat Medicine cooperate in this therapy programme.

Patients can activate the tongue pacemaker themselves before they fall asleep. The device stimulates the lingual nerve (hypoglossal nerve) during inhalation, causing the tongue to move forwards. This prevents the tongue muscles from slackening and blocking the airway. Breathing interruptions are avoided.

Diagnostics

The severity and type of sleep apnoea are diagnosed in the sleep laboratory of the Clinic and Polyclinic for Internal Medicine II at the UKR. In addition, an ENT examination is carried out to determine whether the requirements for implanting a tongue pacemaker are met. There are several criteria that must be met before a tongue pacemaker can be implanted, including an AHI value between 15/h and 65/h, whereby central apnoeas may only be present to a maximum of 25%. In addition, the BMI value must not exceed 35. Prior to implantation, we plan a sleep video endoscopy in which the collapse in the throat is visualised during a sedation phase.

Therapy

Specially trained doctors from the Ear, Nose and Throat Clinic at the UKR implant the tongue pacemaker into the sleep apnoea patient in a surgery under general anaesthesia. Depending on the system, this consists of different components. To do this, the doctors make small incisions under the lower jaw (for the electrode on the lingual nerve) and, if necessary, on the chest (for other components).

Success monitoring and activation

Once the wound has healed, a check-up is carried out three weeks after the surgery and the tongue pacemaker is activated for the first time.

Two different pacemaker systems are currently available: Inspire and Nyxoah. We offer both systems at the UKR. This allows us to find the best individual solution for each patient, regardless of the system.

The systems differ in the number of components to be implanted, the number of electrodes that stimulate the lingual nerve and the way in which the frequency of the stimulation is determined.