Management of a Hypoglossal Nerve, Upper Airway Stimulator in the Pain Patient: Safety Considerations.

Abstract

Background: Upper airway stimulation (UAS) is an emerging neuromodulatory treatment for obstructive sleep apnea (OSA). It involves stimulating the motor fibers of the hypoglossal nerve to prevent airway collapse. Patients with OSA and pain may require radiofrequency ablation (RFA) or electrocautery during surgery. Due to the proximity of UAS leads to cervical facet joints, careful procedural considerations are necessary to prevent complications. This report summarizes best practices for performing RFA or electrocautery in patients with UAS implants, guided by manufacturer safety recommendations and expert consensus statements.

Case presentation: An elderly patient with OSA, successfully treated with Inspire UAS, and chronic cervical facet-mediated pain presented for repeat cervical RFA. The procedure followed manufacturer safety recommendations, including turning off the UAS device prior to the intervention, positioning the grounding pad to avoid current passage through the implant, maintaining distance from the device leads, and using bipolar RFA. The RFA was performed without complications, and the patient experienced significant pain relief without adverse effects.

Conclusion: This case underscores the importance of thorough preprocedural planning when performing RFA in patients with implanted neuromodulation devices. Adhering to manufacturer guidelines can reduce the risk of device interference and associated complications.