Hypoglossal Nerve Stimulation (HGNS) Implant

Hypoglossal nerve stimulation (HNS) is an established implantable therapy for patients with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant of or unable to adhere to continuous positive airway pressure (CPAP). By delivering electrical impulses to the hypoglossal nerve (cranial nerve XII), HNS activates the genioglossus muscle to protrude and stiffen the tongue, thereby preventing pharyngeal airway collapse during sleep. The Inspire® Upper Airway Stimulation system remains the most widely adopted and extensively studied device, with over 100,000 implants performed worldwide since its FDA approval in 2014. Emerging systems, including the Nyxoah Genio® and LivaNova aura6000®, offer alternative stimulation strategies and less invasive implantation approaches, though long-term data for these devices remain limited. Careful patient selection is critical to treatment success. Ideal candidates have an apnea–hypopnea index of 15–65 events per hour, a body mass index below 32 kg/m², and absence of complete concentric palatal collapse on drug-induced sleep endoscopy. The surgical implantation procedure involves a two-incision technique performed under general anesthesia, comprising hypoglossal nerve dissection and stimulation cuff electrode placement via a submandibular incision, and respiratory sensing lead implantation at the fourth intercostal space. Device activation occurs 4–6 weeks postoperatively, followed by titration polysomnography to optimize therapeutic parameters Clinical evidence demonstrates significant reductions in apnea–hypopnea index, improved oxygenation, and sustained quality-of-life benefits over five or more years of follow-up. With a favorable safety profile and high patient satisfaction, HNS represents a significant shift in the surgical management of CPAP-intolerant OSA.