Effects of Hypoglossal Nerve Stimulation on Upper Airway Structure and Function Using Moving Wall Computational Fluid Dynamics Simulations: A Pilot Study

ABSTRACT Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy...

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Veröffentlicht in:	Journal of sleep research Jg. 34; H. 5; S. e70040 - n/a
Hauptverfasser:	Xiao, Qiwei, Ignatiuk, Daniel, Gunatilaka, Chamindu, McConnell, Keith, Schuler, Christine, Romaker, Ann, Ishman, Stacey, Fleck, Robert, Amin, Raouf, Bates, Alister
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England 01.10.2025
Schlagworte:	Adult Airway Resistance - physiology CFD Computer Simulation Electric Stimulation Therapy - methods Four-Dimensional Computed Tomography HGNS Humans Hydrodynamics Hypoglossal Nerve - physiology Inspire Male Middle Aged Pilot Projects Sleep Apnea, Obstructive - diagnostic imaging Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy CFD CT HGNS Inspire
ISSN:	0962-1105, 1365-2869, 1365-2869
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Abstract	ABSTRACT Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy are not well understood. In this pilot study of three male subjects, we propose an innovative, non‐invasive method to quantify the structural and functional changes to the upper airway that occur with HGNS. We used four‐dimensional computed tomography (4DCT) and computational fluid dynamics (CFD) simulations of respiratory airflow to quantify how HGNS changes: (1) airway cross‐sectional area (CSA), (2) work done by muscles and air pressure in dilating and collapsing the airway and (3) airway resistance. Subjects underwent 4DCT under natural stage non‐REM 2 (N2) sleep with and without HGNS. Each patient had concurrent electroencephalograms and airflow measurements. CFD simulations were performed based on anatomy and airway motion from 4DCT images and airflow data. HGNS was associated with an increase in neuromuscular work done in dilating the airway (up to 490%); airway CSA increased by up to 300%. Most motion with HGNS occurred in the oropharynx; changes in the nasopharynx and hypopharynx varied between subjects. Minute ventilation increased in all subjects (15%–36%). Airway resistance decreased across the three subjects (73%–97%). Quantifying the parameters measured in this study may help explain variable responses to HGNS as a treatment for OSA. These procedures may, in future, help predict non‐responders to HGNS, isolate reasons for poor responses, or inform device titration.
AbstractList	Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy are not well understood. In this pilot study of three male subjects, we propose an innovative, non-invasive method to quantify the structural and functional changes to the upper airway that occur with HGNS. We used four-dimensional computed tomography (4DCT) and computational fluid dynamics (CFD) simulations of respiratory airflow to quantify how HGNS changes: (1) airway cross-sectional area (CSA), (2) work done by muscles and air pressure in dilating and collapsing the airway and (3) airway resistance. Subjects underwent 4DCT under natural stage non-REM 2 (N2) sleep with and without HGNS. Each patient had concurrent electroencephalograms and airflow measurements. CFD simulations were performed based on anatomy and airway motion from 4DCT images and airflow data. HGNS was associated with an increase in neuromuscular work done in dilating the airway (up to 490%); airway CSA increased by up to 300%. Most motion with HGNS occurred in the oropharynx; changes in the nasopharynx and hypopharynx varied between subjects. Minute ventilation increased in all subjects (15%-36%). Airway resistance decreased across the three subjects (73%-97%). Quantifying the parameters measured in this study may help explain variable responses to HGNS as a treatment for OSA. These procedures may, in future, help predict non-responders to HGNS, isolate reasons for poor responses, or inform device titration. ABSTRACT Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy are not well understood. In this pilot study of three male subjects, we propose an innovative, non‐invasive method to quantify the structural and functional changes to the upper airway that occur with HGNS. We used four‐dimensional computed tomography (4DCT) and computational fluid dynamics (CFD) simulations of respiratory airflow to quantify how HGNS changes: (1) airway cross‐sectional area (CSA), (2) work done by muscles and air pressure in dilating and collapsing the airway and (3) airway resistance. Subjects underwent 4DCT under natural stage non‐REM 2 (N2) sleep with and without HGNS. Each patient had concurrent electroencephalograms and airflow measurements. CFD simulations were performed based on anatomy and airway motion from 4DCT images and airflow data. HGNS was associated with an increase in neuromuscular work done in dilating the airway (up to 490%); airway CSA increased by up to 300%. Most motion with HGNS occurred in the oropharynx; changes in the nasopharynx and hypopharynx varied between subjects. Minute ventilation increased in all subjects (15%–36%). Airway resistance decreased across the three subjects (73%–97%). Quantifying the parameters measured in this study may help explain variable responses to HGNS as a treatment for OSA. These procedures may, in future, help predict non‐responders to HGNS, isolate reasons for poor responses, or inform device titration. Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy are not well understood. In this pilot study of three male subjects, we propose an innovative, non-invasive method to quantify the structural and functional changes to the upper airway that occur with HGNS. We used four-dimensional computed tomography (4DCT) and computational fluid dynamics (CFD) simulations of respiratory airflow to quantify how HGNS changes: (1) airway cross-sectional area (CSA), (2) work done by muscles and air pressure in dilating and collapsing the airway and (3) airway resistance. Subjects underwent 4DCT under natural stage non-REM 2 (N2) sleep with and without HGNS. Each patient had concurrent electroencephalograms and airflow measurements. CFD simulations were performed based on anatomy and airway motion from 4DCT images and airflow data. HGNS was associated with an increase in neuromuscular work done in dilating the airway (up to 490%); airway CSA increased by up to 300%. Most motion with HGNS occurred in the oropharynx; changes in the nasopharynx and hypopharynx varied between subjects. Minute ventilation increased in all subjects (15%-36%). Airway resistance decreased across the three subjects (73%-97%). Quantifying the parameters measured in this study may help explain variable responses to HGNS as a treatment for OSA. These procedures may, in future, help predict non-responders to HGNS, isolate reasons for poor responses, or inform device titration.Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous positive airway pressure. However, the success rate of HGNS is variable, but the reasons underlying variation in treatment efficacy are not well understood. In this pilot study of three male subjects, we propose an innovative, non-invasive method to quantify the structural and functional changes to the upper airway that occur with HGNS. We used four-dimensional computed tomography (4DCT) and computational fluid dynamics (CFD) simulations of respiratory airflow to quantify how HGNS changes: (1) airway cross-sectional area (CSA), (2) work done by muscles and air pressure in dilating and collapsing the airway and (3) airway resistance. Subjects underwent 4DCT under natural stage non-REM 2 (N2) sleep with and without HGNS. Each patient had concurrent electroencephalograms and airflow measurements. CFD simulations were performed based on anatomy and airway motion from 4DCT images and airflow data. HGNS was associated with an increase in neuromuscular work done in dilating the airway (up to 490%); airway CSA increased by up to 300%. Most motion with HGNS occurred in the oropharynx; changes in the nasopharynx and hypopharynx varied between subjects. Minute ventilation increased in all subjects (15%-36%). Airway resistance decreased across the three subjects (73%-97%). Quantifying the parameters measured in this study may help explain variable responses to HGNS as a treatment for OSA. These procedures may, in future, help predict non-responders to HGNS, isolate reasons for poor responses, or inform device titration.
Author	Schuler, Christine Xiao, Qiwei Gunatilaka, Chamindu Bates, Alister Ignatiuk, Daniel McConnell, Keith Ishman, Stacey Amin, Raouf Romaker, Ann Fleck, Robert
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Cites_doi	10.1038/s41598-021-93769-6 10.3390/healthcare7030093 10.1007/s10439-019-02410-1 10.1016/j.resp.2008.07.027 10.1089/jamp.2023.0023 10.1164/rccm.202006‐2176OC 10.1016/j.wjorl.2015.08.001 10.1152/japplphysiol.00071.2023 10.1016/j.jaerosci.2024.106450 10.1098/rsta.2008.0083 10.1183/09031936.00059414 10.1371/journal.pone.0256460 10.1016/j.jbiomech.2022.111304 10.1016/j.clinbiomech.2017.10.011 10.1164/rccm.201109-1614OC 10.2147/NSS.S275252 10.1016/j.wjorl.2020.02.007 10.1002/cnm.3144 10.1016/j.compbiomed.2020.104099 10.3390/ijerph18041642
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Snippet	ABSTRACT Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate... Hypoglossal nerve stimulation (HGNS) is an innovative alternative treatment option for obstructive sleep apnoea (OSA) in patients unable to tolerate continuous...
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SubjectTerms	Adult Airway Resistance - physiology CFD Computer Simulation Electric Stimulation Therapy - methods Four-Dimensional Computed Tomography HGNS Humans Hydrodynamics Hypoglossal Nerve - physiology Inspire Male Middle Aged Pilot Projects Sleep Apnea, Obstructive - diagnostic imaging Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy
Title	Effects of Hypoglossal Nerve Stimulation on Upper Airway Structure and Function Using Moving Wall Computational Fluid Dynamics Simulations: A Pilot Study
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