Hypoglossal Nerve Stimulator for Obstructive Sleep Apnea (OSA)

Hypoglossal nerve stimulators offer a surgical option for certain people with moderate to severe obstructive sleep apnea (OSA). An implanted device delivers gentle electrical stimulation to the hypoglossal nerve, which controls tongue movement. This stimulation helps move the tongue forward during sleep, reducing airway blockage and helping you breathe easily throughout the night.

OSA can affect much more than a good night’s sleep. Left untreated, it can leave you feeling tired during the day, make it difficult to concentrate and contribute to serious health issues. Continuous positive airway pressure (CPAP) is often the first treatment recommended for OSA, but it does not work for everyone. 

At Houston Methodist, our otolaryngologists (ENT doctors) and sleep surgery specialists look beyond a single procedure or device. We carefully evaluate your sleep apnea, airway anatomy, overall health and treatment goals to determine whether hypoglossal nerve stimulator surgery — or another approach — is the best path forward for you.

What Is Hypoglossal Nerve Stimulator Surgery?

Hypoglossal nerve stimulator surgery is an outpatient procedure that places a small device in your body to help keep your upper airway open during sleep. When you sleep, the muscles supporting your tongue and other soft tissues relax. For people with OSA, the tongue, soft palate or tissues can collapse into the airway and repeatedly interrupt breathing.

A hypoglossal nerve stimulator delivers electrical stimulation to activate the muscles controlling your tongue, helping prevent it from falling backward and blocking the airway. Unlike CPAP, which uses pressurized air delivered through a mask to hold the airway open, hypoglossal nerve stimulation works from inside the body. You activate the device before going to sleep and turn it off when you wake up.

Treatment begins with understanding why your airway becomes blocked during sleep. Your evaluation may include a review of your previous sleep studies, CPAP experience, symptoms, medical history and anatomy. Some patients also undergo drug-induced sleep endoscopy (DISE).

During DISE, you receive sedation while your surgeon examines your upper airway using a small camera passed through the nose. This allows your doctor to observe how the airway behaves in a sleep-like state and identify whether obstruction occurs at the soft palate, tongue or another area — and whether there is one blockage site or several.

If your doctor determines that hypoglossal nerve stimulation is appropriate for your unique circumstances, he or she will perform the surgery under general anesthesia. 

Hypoglossal nerve stimulation can significantly reduce the severity of OSA, but no treatment works the same way for everyone.

Clinical results vary based on the device, airway anatomy, OSA severity and other individual factors. Overall, both unilateral and bilateral hypoglossal nerve stimulators have demonstrated meaningful reductions in sleep apnea events and quality of life.

Your surgeon will discuss the best option for you based on your health, anatomy and treatment goals.

What Conditions Does Hypoglossal Nerve Stimulation Treat?

Hypoglossal nerve stimulation is used to treat moderate to severe obstructive sleep apnea. OSA occurs when the upper airway repeatedly becomes blocked during sleep. Hypoglossal nerve stimulation addresses this mechanical obstruction by activating muscles that help move the tongue forward and maintain an open airway.

Hypoglossal nerve stimulation does not treat central sleep apnea, which occurs when the brain does not consistently send the signals needed to control breathing. Because obstructive and central sleep apnea have different causes and treatment approaches, an accurate diagnosis is an important first step.

Some people have both obstructive and central breathing events. Your specialist will review your sleep study, performed when OSA is suspected, and your overall health to determine whether nerve stimulation may be appropriate for you.

Who Qualifies for Nerve Stimulator Surgery?

While not everyone with OSA is a candidate for a nerve stimulator, other surgical or non-surgical treatments may be appropriate depending on where and how your airway becomes blocked during sleep. Because OSA can result from obstruction at the nose soft palate, tonsils, tongue, epiglottis or jaw, our specialists perform a comprehensive evaluation, including a sleep study, to identify the source of obstruction and tailor treatment to your individual needs.

Hypoglossal nerve stimulator surgery may be appropriate for patients who:

• Are 18 years or older
• Have airway obstruction that occurs at the palate and/or base of the tongue
• Have a BMI less than 40
• Have a moderate to severe obstructive sleep apnea (not mild)
• Have tried CPAP but cannot use it consistently, cannot tolerate it or continue to have OSA despite treatment

Preparing for Hypoglossal Nerve Stimulator Surgery

Before surgery, your care team will explain how to prepare based on your health, medications and the specific device being implanted. Follow the instructions provided by your surgical team carefully. Preparation includes:

• Reviewing your sleep study and previous OSA treatments
• Completing DISE or another airway evaluation, when appropriate
• Reviewing all medications and supplements with your care team
• Following instructions about when to stop eating and drinking before surgery
• Arranging for a trusted adult to drive you home after the procedure
• Planning for a short period of reduced physical activity as you recover

Recovering From Hypoglossal Nerve Stimulator Surgery

Recovery varies depending on the type of stimulator implanted, but most patients return home the day of the surgery and experience relatively limited downtime. Your exact timeline may vary. Your care team will continue monitoring and adjusting therapy as needed to help make treatment both comfortable and effective.