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Purpose <p>To develop and evaluate a novel multimodal platform that synchronously measures tongue motion, retropalatal area, pharyngeal pressure, and nasal airflow during drug-induced sleep endoscopy (DISE) in patients with hypoglossal nerve stimulation (HGNS), with the aim of elucidating the physiologic mechanisms underlying response variability.</p> Methods <p>Four patients with prior HGNS implantation underwent enhanced DISE using a custom setup integrating submental ultrasound, nasolaryngoscopy, pharyngeal manometry, pneumotachography, and EMG recording. Five breaths with and without HGNS were analyzed per subject (<i>n</i> = 40 breaths). Measurements were recorded at peak inspiratory effort and synchronized across modalities. Tongue motion was quantified in polar and Cartesian coordinates; retropalatal area and nasal airflow were measured using standardized image analysis and flow tracings.</p> Results <p>All participants tolerated the protocol without adverse events. Tongue motion was greatest at 30° and 45° from the mandibular-hyoid plane (9.4 ± 1.1&#xa0;mm and 7.1 ± 1.2&#xa0;mm, respectively, <i>P</i> &lt; 0.05), with minimal changes in tongue height at 90° (1.9 ± 1.4&#xa0;mm, <i>P</i> &gt; 0.05). Three patients showed improved retropalatal area, reduced negative pharyngeal pressure, and increased nasal airflow with HGNS. One patient, despite visible tongue movement, showed minimal improvement in airway patency and developed more negative pharyngeal pressure with stimulation.</p> Conclusions <p>This study introduces a novel, physiologic DISE platform capable of quantifying HGNS-related changes in tongue mechanics and upper airway dynamics. The findings suggest that visible tongue motion alone is insufficient to predict functional response and highlight the importance of pressure-flow relationships in HGNS efficacy. This platform may aid in guiding post-implant troubleshooting and provides a framework for future studies evaluating prospectively enrolled patients.</p>

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Translating hypoglossal nerve stimulation tongue movement into functional response during drug-induced sleep endoscopy: a proof-of-concept study

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Tice R. Harkins,
  • Everett G. Seay,
  • Eric Thuler,
  • Raj C. Dedhia

摘要

Purpose

To develop and evaluate a novel multimodal platform that synchronously measures tongue motion, retropalatal area, pharyngeal pressure, and nasal airflow during drug-induced sleep endoscopy (DISE) in patients with hypoglossal nerve stimulation (HGNS), with the aim of elucidating the physiologic mechanisms underlying response variability.

Methods

Four patients with prior HGNS implantation underwent enhanced DISE using a custom setup integrating submental ultrasound, nasolaryngoscopy, pharyngeal manometry, pneumotachography, and EMG recording. Five breaths with and without HGNS were analyzed per subject (n = 40 breaths). Measurements were recorded at peak inspiratory effort and synchronized across modalities. Tongue motion was quantified in polar and Cartesian coordinates; retropalatal area and nasal airflow were measured using standardized image analysis and flow tracings.

Results

All participants tolerated the protocol without adverse events. Tongue motion was greatest at 30° and 45° from the mandibular-hyoid plane (9.4 ± 1.1 mm and 7.1 ± 1.2 mm, respectively, P < 0.05), with minimal changes in tongue height at 90° (1.9 ± 1.4 mm, P > 0.05). Three patients showed improved retropalatal area, reduced negative pharyngeal pressure, and increased nasal airflow with HGNS. One patient, despite visible tongue movement, showed minimal improvement in airway patency and developed more negative pharyngeal pressure with stimulation.

Conclusions

This study introduces a novel, physiologic DISE platform capable of quantifying HGNS-related changes in tongue mechanics and upper airway dynamics. The findings suggest that visible tongue motion alone is insufficient to predict functional response and highlight the importance of pressure-flow relationships in HGNS efficacy. This platform may aid in guiding post-implant troubleshooting and provides a framework for future studies evaluating prospectively enrolled patients.