Hypoglossal Nerve Stimulation

It was noticed that patients who had a pacemaker inserted to control heart problems also experienced reduced snoring. In 2002 researchers¹ found that increasing by increasing the heart rate to approx 15 beats faster than what was considered normal that apneas were greatly reduced.

Separately the effect of hypoglossal nerve stimulation on the breathing airways, the breathing airflow and snoring has been investigated by several research projects of over the past 20 years.^2,3,4,5,6,7 The results showed that activating the nerve either reduced apnea episodes and or increased breathing airflow. These studies used direct electrical stimulation of the nerve to gain these results.

The result of this research has resulted in a product coming to market that can stimulate the hypoglossal nerve via an electrical pulse when air pressure in the throat falls below a predetermined value. The device is similar to a pace maker in that it fits under the skin and sends an electrical pulse to a specific area. It ahs even been referred to 9in the media as the snoring pacemaker.

Interestingly the hypoglossal motoneurons^8,9 have been shown to also be activated by nitric oxide and nitric oxide is made in the sinuses of the nose. When nose breathing the NO is passed along the airpassages and into the lungs. The otherwise toxic gas has many important roles in the body as a signaller, especially in regards to the dialtion of smooth muscle tissue. Nitric oxide also has a very short half life, less than 2 seconds so the effects both positive and negative once passing from the nasal passsages is short lived.

Manual minipulation of the NeckThe hypoglossal nerve extends out through the gaps between the upper cervical joints in the spine. Any impingement on the nerve can cause a determental effect on the nerves ability to fuction. This could be why chiroparctos and osetopahts have had patients report a reduction in snoring after treatment when presenting for a sore or stiff neck. Freeing up the joints of the neck enables the nerves to fuction to their full potential.

Snoring and ThyroidismThe hypoglossal nerve also sends signals to the thyroid muscle. An ill fuctioning thyroid and in particualr hypothyroidism has been linked to snoring. Autonomic nervous regulation of the thyroid secretion is not fully understood but its not a giant leap to suspect thyroid dusfuction could be caused by the supporting muscles not operting as they should.

The role of the hypoglossal nerve in relation to snoring and sleep apnea is all quite new. Hypoglossal Nerve Activaiton as a therapy shows much promise and the morbity of snoring and sleep apnea in patients who use the solution will give a better understanding of long term benefits. When radical sugery for snoring first became popular the initial results were very promising but studies since have shown the long term success to be not nearly as good and hence the loss in popularity of such proceedures.

Return to Snoring Aids Page

References

1.Stephane Garrigue, M.D.et el, Atrial overdrive pacing reduces episodes of sleep apnea , N Engl J Med 2002; 346:404-412

2.David W. Eisele, MD; Philip L. Smith, MD; Daniel S. Alam; Alan R. Schwartz, MD, Direct Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea, Arch Otolaryngol Head Neck Surg. 1997;123(1):57-61.

3.Alan R. Schwartz et el., Therapeutic Electrical Stimulation of the Hypoglossal Nerve in Obstructive Sleep Apnea, Arch Otolaryngol Head Neck Surg. 2001;127:1216-1223.

4. Alan R. Schwartz et el., Effect of Electrical Stimulation of the Hypoglossal Nerve on Airflow Mechanics in the Isolated Upper Airway, Am. J. Respir. Crit. Care Med. May 1, 1993 vol. 147 no. 5 1144-1150

5. W Hida, H Kurosawa, S Okabe, Y Kikuchi, J Midorikawa, Y Chung, T Takishima and K Shirato, Hypoglossal nerve stimulation affects the pressure-volume behavior of the upper airway. Am. J. Respir. Crit. Care Med. February 1, 1995 vol. 151 no. 2 455-460

6. David W. Eisele, MD; Alan R. Schwartz, MD; Anil Hari, MD; David C. Thut; Philip L. Smith, MD, The Effects of Selective Nerve Stimulation on Upper Airway Airflow Mechanics, Arch Otolaryngol Head Neck Surg. 1995;121(12):1361-1364.

7.Fietze I, Röttig J, Quispe-Bravo S, Riedel F, Witte J, Baumann G, Witt C, Sleep Apnea Syndrome in Patients with Cardiac Pacemaker, Respiration 2000, Vol. 67, No. 3

8.Fernando Montero, Federico Portillo, David González-Forero, Bernardo Moreno-López, The nitric oxide/cyclic guanosine monophosphate pathway modulates the inspiratory-related activity of hypoglossal motoneurons in the adult rat, European Journal of Neuroscience, Volume 28, Issue 1, pages 107–116, July 2008

9.Wenker IC, Benoit JP, Chen X, Liu H, Horner RL, Mulkey DK , Nitric oxide activates hypoglossal motoneurons by cGMP-dependent inhibition of TASK channels and cGMP-independent activation of HCN channels, J Neurophysiol. 2011 Nov 30

New! Comments