Targeted Hypoglossal Nerve Stimulation for Patients With Obstructive Sleep Apnea: A Randomized Clinical Trial.

Importance: Evidence is lacking from randomized clinical trials of hypoglossal nerve stimulation in obstructive sleep apnea (OSA).

Objective: To evaluate the safety and effectiveness of targeted hypoglossal nerve stimulation (THN) of the proximal hypoglossal nerve in patients with OSA.

Design, Setting, And Participants: This randomized clinical trial (THN3) was conducted at 20 centers and included 138 patients with moderate to severe OSA with an apnea-hypopnea index (AHI) of 20 to 65 events per hour and body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or less.

Oral Appliances for Snoring and Obstructive Sleep Apnea.

Obstructive sleep apnea is a common condition, caused primarily by narrowing of the nasal and pharyngeal airway, leading to partial or complete airway collapse during sleep. Treatment with positive airway pressure (PAP) is considered first-line therapy, due to an efficacy rate of approximately 95%, yet long-term compliance with PAP is less than 40%. The efficacy of a sleep oral appliance is lower than PAP, yet it may have similar effectiveness.

Nasal Surgery for Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea is a common condition, primarily caused by narrowing of the nasal and pharyngeal airway. Treatment with continuous positive airway pressure (CPAP) is considered the first line of therapy, but long-term compliance is only about 40%, often because of nasal obstruction. Any nasal obstruction can worsen CPAP compliance.

Anesthetic and postoperative management of the obstructive sleep apnea patient.

Sleep apnea patients pose a challenge for surgeons, anesthesiologists, and surgical facilities as there is increased risk for anesthetic and postoperative complications. Precautions before and after surgery minimize these risks. Screening for sleep apnea should be done for all surgical patients.

Preoperative and postoperative management of obstructive sleep apnea patients.

Safe perioperative management of patients with obstructive sleep apnea (OSA) requires special attention to preoperative and postoperative care. Patients with OSA are more likely to have comorbidities including hypertension, esophageal and laryngopharyngeal reflux disease, coronary artery disease, and obesity. Obesity may also contribute to deep vein thrombosis and pulmonary emboli.