An Alternative to CPAP for Selected Patients with Obstructive Sleep Apnoea
Hypoglossal nerve stimulation (HNS) is an advanced surgical treatment for obstructive sleep apnoea (OSA). The treatment works by stimulating the nerve that controls tongue movement during sleep, helping to keep the airway open and reduce episodes of airway obstruction.
Tom Pepper is a Consultant Oral and Maxillofacial Surgeon in London with specialist expertise in airway surgery, orthognathic surgery, and the surgical management of obstructive sleep apnoea.
Consultations are available in London at Harley Street and Cromwell Hospital.
What Is Hypoglossal Nerve Stimulation?
Obstructive sleep apnoea occurs when the airway repeatedly collapses during sleep, interrupting breathing and reducing sleep quality.
Hypoglossal nerve stimulation addresses one of the most common causes of airway obstruction: collapse at the level of the tongue base.
The treatment works by:
- Delivering gentle stimulation to the hypoglossal nerve
- Moving the tongue forward during inspiration
- Preventing airway collapse
- Maintaining airflow throughout the night
The result is improved airway patency without the need for a CPAP mask.
Who May Benefit from Hypoglossal Nerve Stimulation?
Hypoglossal nerve stimulation may be considered for adults with:
- Moderate obstructive sleep apnoea
- Severe obstructive sleep apnoea
- CPAP intolerance
- Difficulty complying with CPAP treatment
- Persistent symptoms despite conventional management
Suitable patients often report:
- Loud snoring
- Daytime fatigue
- Excessive daytime sleepiness
- Poor sleep quality
- Difficulty tolerating CPAP masks
Not all patients with sleep apnoea are suitable candidates, and careful assessment is essential.
Available Systems
Two main systems are currently used:
Inspire®
The Inspire® system is the most widely recognised sleep apnoea implant. It consists of:
- A stimulation lead attached to the hypoglossal nerve
- A small implanted generator
- A breathing sensor positioned within the chest
The device is activated during sleep using a handheld remote.
Nyxoah Genio®
The Genio® system uses a different approach. Features include:
- Bilateral stimulation of the hypoglossal nerve
- No implanted breathing sensor
- External activation during sleep
- Less invasive implantation
Both systems aim to reduce airway collapse and improve breathing during sleep, using slightly different technologies. The most appropriate option depends on individual anatomy and clinical circumstances.
Assessment and Selection
A detailed evaluation is required before treatment.
This may include:
- Sleep study results
- Clinical examination
- Drug-induced sleep endoscopy (DISE) to assess the airway
DISE is particularly important in determining whether the pattern of airway collapse is suitable for this type of treatment.
The Procedure
Hypoglossal nerve stimulation surgery is performed under general anaesthetic.
The procedure involves:
- Identification of the hypoglossal nerve in the neck
- Placement of a stimulation electrode
- Implantation of the selected device
- Careful wound closure
The procedure is typically well tolerated and performed as a planned, elective intervention.
After Treatment
The device is usually activated a few weeks after surgery.
- Settings are adjusted gradually to achieve optimal effect
- Follow-up includes monitoring sleep quality and symptom improvement
- Ongoing adjustments may be made to refine performance
Patients use the system nightly, with control over activation.
Results
Hypoglossal nerve stimulation can lead to:
- Reduction in apnoea events
- Improved sleep quality
- Reduced daytime fatigue
- Better overall quality of life
Outcomes depend on appropriate patient selection and careful optimisation of the device.
Hypoglossal Nerve Stimulation vs CPAP
Continuous Positive Airway Pressure (CPAP) remains the first-line treatment for obstructive sleep apnoea.
Advantages include:
- Non-surgical
- Highly effective when used consistently
- Widely available
Limitations include:
- Mask intolerance
- Comfort issues
- Compliance difficulties
Hypoglossal Nerve Stimulation and Jaw Surgery
Some patients with obstructive sleep apnoea may benefit from orthognathic surgery or maxillomandibular advancement (MMA) rather than hypoglossal nerve stimulation.
Assessment includes consideration of:
- Facial skeletal anatomy
- Airway dimensions
- Severity of sleep apnoea
- Previous treatment history
As a Consultant Oral and Maxillofacial Surgeon, Tom Pepper is able to assess both implant-based and skeletal approaches to airway improvement, helping ensure that treatment recommendations are tailored to the individual patient.Hypoglossal Nerve Stimulation
A Considered Approach to Sleep Surgery
Surgical treatment for sleep apnoea requires careful selection and planning.
We prioritise:
- Identifying the correct site of obstruction
- Matching treatment to anatomy and physiology
- Avoiding unnecessary or ineffective interventions
- Delivering predictable, evidence-based results
Hypoglossal nerve stimulation is used where it is appropriate—not as a universal solution.
Frequently Asked Questions
What is an Inspire sleep apnoea implant?
Inspire® is a hypoglossal nerve stimulation system designed to treat obstructive sleep apnoea by preventing airway collapse during sleep.
Is hypoglossal nerve stimulation better than CPAP?
Not necessarily. CPAP remains the most effective treatment for many patients. Hypoglossal nerve stimulation is typically considered when CPAP cannot be tolerated.
Can hypoglossal nerve stimulation stop snoring?
Many patients experience significant reductions in snoring, although results vary.
Will I still need CPAP?
Some patients are able to discontinue CPAP, although this depends on individual circumstances.
How do I know if I’m suitable?
Suitability is determined through assessment of sleep studies, airway anatomy, body weight, and findings on drug-induced sleep endoscopy.
Consultation
A detailed consultation allows for full assessment of your sleep apnoea, prior treatments, and suitability for advanced interventions such as hypoglossal nerve stimulation.
Arrange a Consultation
For assessment of obstructive sleep apnoea and suitability for hypoglossal nerve stimulation in London, arrange a consultation to discuss your options in detail.