Effekte der neuromuskulären Stimulation des distalen N. hypoglossus auf die Funktion der oberen Atemwege und den inspiratorischen Atemfluss

Conclusion: For the obstructive sleep apnea the alternative therapy options compared with the CPAP therapy are limited. Only the loss of weight, the operative maxillo–mandibular Osteotomie (MMO) or the uvulopalatopharyngoplastic (UVPP)can unessential influence the obstructive sleep apnea. So the gold standard is still the continuous pressure support with a nasal mask or face mask. It is necessary for this therapy that the patient is used to wear such a mask and can tolerate the applied pressure. The documented long time compliance of 50 to 80% for the CPAP-therapy shows the necessarity for a clinical evaluation of therapy options. We could show that for patients with moderate collapsibility of the upper airways determined by the measurement of the critical pharyngeal closing pressure, the implantation of a pacemaker system for breath triggered neuromuscular stimulation of the hypoglossal nerve can be an effective therapy for the obstructive sleep apnea. In mean the unilateral stimulation of the hypoglossal nerve could reduce the apnea/hypopnea index in REM- and NREM-sleep. The sleep quality of the patients was improved by the electrical stimulation during sleep because of the increase of the deep sleep parts. In the special examined sub set group (n = 4) we could show a decrease of the critical pharyngeal pressure (Pcrit) up to 5 cm H2O water column. Furthermore we could show that the night activity of the pacemaker neither influence the mechanical movement of the tongue (Protrusion) nor the sleep quality. Even the nervale pacemaker seems to be an alternative treatment for the obstructive sleep apnea so the qualitative results are only comparative with the results of the UVPP or the MMO. To increase the achieved results both sides nervale stimulation could take into consideration. At least the effects of the stimulation during night must be measured at the daily efficiency and cardiovascular functions, so the electrical stimulation of the hypoglossal nerve can get established for a therapeutic option for the treatment of obstructive sleep apnea.