Use of Bipolar Nerve Stimulator as an Alternative to Neural Integrity Monitor During Hypoglossal Nerve Stimulator Placement

Hypoglossal nerve stimulation is a key step in insertion of a hypoglossal nerve stimulator for sleep apnea. The hypoglossal nerve stimulator works through assessment of apneic events that result in stimulation of the protrusion fibers of the hypoglossal nerve causing protrusion of the tongue and opening of the oropharynx resulting in ability for the patient to adequately breath. Therefore, during insertion of the hypoglossal nerve stimulator, a key portion of the procedure is inclusion of the protrusive fibers of the hypoglossal nerve and exclusion of the retrusive fibers. In the past, this was assessed by neural integrity monitor, which has limitations such as difficult and time-consuming setup, bulky equipment, and increased sharps injury. Our institution, North Memorial Hospital in Robbinsdale, Minnesota, has updated our protocol to utilize a bipolar nerve stimulator, which has decreased operating time and use of sharps and increased accuracy of the procedure. This article further discusses utilization and benefit of the bipolar nerve stimulator for placement of hypoglossal nerve stimulators for sleep apnea patients.