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David W. Eisele, MD; Philip L. Smith, MD; Daniel S. Alam; Alan R. Schwartz, MD

Arch Otolaryngol Head Neck Surg. 1997;123(1):57-61.

Abstract
Objectives
To determine the motor responses resulting from direct electrical stimulation of the hypoglossal (HG) nerve and to correlate these responses to changes in upper airway patency during sleep.

Design
The motor effects of direct electrical stimulation of the main trunk of the HG nerve and the branch that supplies the genioglossus muscle during anesthesia and wakefulness were assessed visually. Responses in airflow during sleep to HG nerve stimulation were assessed with standard polysomnographic techniques.

Setting
University medical center.

Patients
Fifteen patients undergoing a surgical procedure that involved the neck that exposed the HG nerve and 5 volunteer patients with obstructive sleep apnea constituted the study population.

Interventions
The main trunk (n=3) and genioglossus branch (n=2) of the HG nerve were stimulated electrically with a half-cuff tripolar electrode.

Results
Stimulation of the branch of the HG nerve that innervates the genioglossus muscle caused protrusion and contralateral deviation of the tongue. Stimulation of the main trunk of the HG nerve caused slight ipsilateral deviation and retrusion of the tongue. The arousal threshold for stimulation exceeded the motor recruitment threshold by 0.8±0.4 V. Inspiratory airflow increased in all patients by 184.5±61.7 mL/s (mean±SD; P=.02, analysis of variance) with stimulation.

Conclusion
Direct HG nerve stimulation below the arousal threshold can improve airflow in patients with obstructive sleep apnea.

Arch Otolaryngol Head Neck Surg. 1997;123:57-61

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery (Dr Eisele and Mr Alam), and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (Drs Smith and Schwartz), The Johns Hopkins University School of Medicine, Baltimore, Md.

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