Upper airway stimulation for moderate-to-severe sleep apnea

Obstructive sleep apnea is a sleep-related breathing disorder that is caused by a collapse of the upper airway due to insufficient muscular tone of the tongue and/or airway dilator muscles. Current standard therapy is the CPAP therapy, which is limited in its effectiveness due to poor compliance. A new functional therapy approach is the stimulation of the hypoglossal nerve (HNS) by an implantable device to restore the tone of the upper airway dilator muscles. A systematic literature review yielded 2 RCTs and 7 single arm studies. One RCT showed a worsening of symptoms one week after withdrawal of the therapy, but only in a selected population of respondents to prior therapy. A second RCT did not show any significant differences between study groups 6 months after randomisation to HNS vs. sham stimulation. Based on the current evidence, a reimbursement is not recommended for now, with a re-evaluation planned for 2018.