International Journal of Engineering Trends and Technology (IJETT) – Volume22 Number 6- April 2015
Comparative Study of Tongue Implants for Sleep
Apnoea Control
Lavanya Ramnath
Smeet Doshi
Manali Godse
D. J. Sanghvi College of Engineering
Mumbai, India
D. J. Sanghvi College of Engineering
Mumbai, India
D. J. Sanghvi College of Engineering
Mumbai, India
Abstract—In this paper we are studying the feasibility of
using tongue implants such as stimulators to prevent airway
obstruction in patients with obstructive sleep apnea (OSA).
Conventional methods used to control sleep apnoea like
Continuous
Positive
Airway
Pressure
(CPAP)
and
Uvulopalatopharyngoplasty (UPPP) helps to keep the airways
open but with the use of heavy and uncomfortable masks or
extensive surgery procedures. Hypoglossal (HG) nerve
stimulation of the muscles of the tongue has been reported to pull
open the airway and reduce the severity of sleep disordered
breathing without the use of heavy masks and less cumbersome
surgery procedures. Hypoglossal Nerve Stimulation System
(HNSS), Nyxoah implants and flat interface nerve electrode
(FINE) have been compared to elucidate all possible ways of
controlling sleep apnoea.
through the throat more easily when the patient breathes and
hence the severity of obstructive sleep apnoea is reduced.
CPAP is generally used after the surgery.
II. HYPOGLOSSAL NERVE STIMULATION SYSTEM [2]
Breathing
Sensor Lead
Pacemakersize device in
the chest
Stimulation
lead for
hypoglossal
nerve
Keywords—apnoea; snoring; hypoglossal; neurostimulator;
uvulopalatopharyngoplasty
I. INTRODUCTION
Sleep apnoea is called the snorer’s disease.It is a serious
problem because the person stops breathing several times
during his sleep. Due to this the brain and other body parts may
not receive required amount of oxygen. Sleep apnoea can be of
following types:
1) Central apnoea: Breathing is interrupted by lack of
respiratory effort.
2) Obstructive apnoea: Breathing is interrupted by
physical block to air flow despite respiratory effort.
3) Mixed apnoea: It is a combination of central and
obstructive apnoea.
Effects of any of these types of sleep apnoea can cause many
health problems. The common risk factors include high blood
pressure, stroke, heart failure, heart attack, diabetes,
depression, headache and weight gain [1].Tongue snorers
constitute 60% of snorers. Sleep apnoea affects four out of
hundred men and two out of hundred women.[2] The most
commonly used methods to tackle sleep apnoea include
Continuous Positive Airway Pressure (CPAP) and
Uvulopalatopharyngoplasty (UPPP). In CPAP therapy, a mask
is used by patients. A pump provides the mask with positive
flow of air which passes through the nasal passage and helps
in
keeping
the
airway
open.In
Uvulopalatopharyngoplasty(UPPP) procedure excess tissue in
the throat such as uvula, soft palate, tonsils etc. is removed in
order to make the airway wider. This allows air to move
ISSN: 2231-2803
Fig. 1 Block Diagram showing the working of pacemaker HNSS
The CPAP mask causes discomfort and hence most of the
sufferers dislike using it regularly. To overcome this problem
and to provide a permanent solution, an implant called the
Hypoglossal Nerve Stimulation System is brought into use. It
causes the muscles of the tongue to contract, pulls the tongue
forward and pulls open the airway by controlling the soft
tissue in the walls of the airway. In this treatment a small
electrode is placed below the tongue next to the hypoglossal
nerve.A pacemaker-size generator is implanted in a pocket
which is surgically created in the chest.Wires are passed under
the skin which connects the pacemaker-size generator to the
electrodes in the tongue.Changes in the air pressure in the
throat are detected by tiny sensor wires which are tunneled
into the trachea from the generator. The block in the airway
can be detected when the pressure gradually drops pulling the
tongue muscles and thus enabling the patient to breathe again
properly. Research that was carried out at Sir Charles Gairdner
Hospital in Perth, Australia, shows how effective the therapy
is in tackling the issues related to sleep apnoea. The trials were
carried out on 21 patients from the age group of 43 to 63 years
suffering from different levels of sleep apnoea, who were
supervised for six months after the device was implanted. The
doctors used the apnoea-hypopnea index to assess severity of
the symptoms. Results showed a considerable drop of severity
levels and daytime drowsiness rates also droppedresulting in
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International Journal of Engineering Trends and Technology (IJETT) – Volume22 Number 6- April 2015
an increase in quality of life. Another trial published in the
American Journal of Respiratory and Critical Care Medicine
included 30 patients andit showed that the device was quite
successful in maintaining constant air flow at night.
these muscles at a time that is selective stimulation reduces
discomfort of the HG nerve which can be achieved by using
FINE. (flat interface nerve electrode). Cuff electrodes are used
for the stimulation. FINE has been tested on beagles so far and
the selective stimulation has proved to be successful.
V. SUMMARY AND CONCLUSION
III. NYXOAH IMPLANTS
Neurostimulation is a useful alternative to CPAP. Nyxoah
implant provides neurostimulation. It is tiny and can be easily
implanted.
METHOD
CPAP
UPPP
Hypoglossal
Nerve
Stimulation
System
Fig. 2The components of Nyxoah implants [3]
This neurostimulator measures 20mm in diameter and 2.5mm
in thickness. It is designed to be implanted close to the nerves
of the tongue muscle by a single small incision.[3] The
implant is placed in its own special delivery tool making it
easy for the surgeons for correct placement. The placement
procedure can be surgically completed in less than an hour.
The advantages of this implant include a short and less risky
procedure and low surgical cost. Once placed, the implant
does not migrate and provides maximum comfort. As
compared to other implants that requirereplacement after 5
years, Nyxoah implants have a lifetime of at least 12 years.[3]
Nyxoah
Implant
FINE
ADVANTAGE
Keeps airway open
during sleep
No opening made in
trachea during
surgery
Use of heavy mask as
in CPAP is avoided
DISADVANTAGE
Heavy mask
Ultra-small,
implanted by making
small incision with
large lifetime
Selective stimulation
of HG nerve
Not documented in
reference papers.
CPAP has to be
used even after
surgery
Complexity of the
implant due to
electrode in chest
cavity and many
wires tunneled.
Product is not
tested on humans
yet
REFERENCES
IV. ADVANCEMENTS [4]
The stimulation of the Hypoglossal nerve (HG nerve) as a
whole in the previously discussed methods were successful in
eliminating the problem of airway obstruction in acute patient
trials. But, when the whole HG nerve was stimulated the
protrusor as well as the retrusor muscles responded to the
stimulus. Due to this the extrinsic tongue muscles are excited
for protrusion and retraction of the intrinsic muscle, tongue as
well as the geniohyoid muscle. Stimulation of any one type of
ISSN: 2231-2803
[1]
[2]
[3]
[4]
[5]
www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea
www.big-wife.com/pacemaker-under-your-tongue-that-stops-yousnoring/
www.medgadget.com
nyxoah-prod.eu1.frbit.net/product
Yoo,
P.B.
;
Sahin,
M.
;
Durand,
D.M.
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