• Faisal N Zaidi, Paul Meadows, Ofer Jacobowitz, and Terence M Davidson.
• Imthera Medical, Inc., San Diego, CA, USA. Hudson Valley Ear, Nose & Throat PC, Middletown, NY, USA. New York Presbyterian Hospital/Columbia University and Attending, Mount Sinai Medical Center and Sleep Surgery and Sleep Medicine, New York, NY, USA. Head & Neck Surgery Clinic, UCSD Hillcrest-Medical Offices North, University of California San Diego, San Diego, CA, USA.
• Neuromodulation. 2013 Jul 1;16(4):376-86; discussion 386.

Introduction Obstructive sleep apnea (OSA) is a chronic condition that affects millions adults. The effective standard treatment is positive airway pressure (PAP). However, approximately half of the patients that are prescribed PAP are unable or unwilling to comply with this therapy. Untreated OSA ultimately leads to very serious comorbidities. An alternative therapy for this patient population, therefore, is desirable. Hypoglossal nerve (HGN) stimulation is under investigation by multiple groups as a possible alternative therapy for OSA.ObjectiveTo understand the underlying mechanisms of actions related to HGN stimulation, and the implication of this knowledge for specifying and designing a neurostimulation system for the treatment of OSA.Results Loss of lingual and pharyngeal tone within a narrow airway is the primary mechanism for OSA. Posterior and anterior tongues are different in their anatomy and physiology. Muscle fibers in the posterior tongue are predominantly fatigue resistant that are responsible for the long sustained tonic activities required for maintaining the tongue's position and preventing its mass from falling into the retroglossal airway. The human tongue is a muscular hydrostat and hence would benefit from a sophisticated HGN stimulation system that is capable of achieving a concerted spatio-temporal interplay of multiple lingual muscles, including retrusors.Conclusion Targeted neurostimulation of the proximal HGN presents as a viable system approach that is far more versatile and physiologic and quite different than prior systems.© 2012 International Neuromodulation Society.

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