Hypoglossal nerve stimulation with Inspire: An operative technique

Objective

Obstructive sleep apnea is a chronic medical condition with a significant prevalence in Japan, estimated to be up to 22.3 % of the male working age population with moderate to severe OSA. Hypoglossal nerve stimulation (HNS) is now an established surgical treatment for obstructive sleep apnea. The surgical technique of the Inspire device has not been published in Japan.

Methods

This study involves combining existing best practice surgical techniques for hypoglossal stimulation implantation with the authors’ unique experiences.

Results

Surgical placement of the Inspire device is a safe and standardized operation. The surgery involves four principal steps: placement of the stimulation lead, placement of the sensing lead, tunneling of the stimulation lead with connection to the implantable pulse generator (IPG), and intraoperative functional testing. There is a standardized technique for these procedures which is discussed in detail. We also discuss known risks to the procedure.

Conclusion

Hypoglossal nerve stimulation with Inspire is a paradigm shift in the surgical treatment of obstructive sleep apnea. HNS is a surgery that can be readily learned and incorporated into a head and neck surgery practice with familiar technique and anatomy to other procedures within an otolaryngologists’ repertoire. A consistent surgical approach can maximize outcomes, reduce complications, and accelerate operative time.