Hypoglossal Nerve Stimulation (HGNS) is emerging as a surgical alternative for patients with obstructive sleep apnoea who cannot tolerate continuous positive airway pressure (CPAP) therapy. According to the NHS, sleep apnoea causes breathing to repeatedly stop and start during sleep, leading to symptoms such as loud snoring, choking, and chronic fatigue. While CPAP remains the primary treatment, HGNS offers a surgical option for extreme cases, with approximately 125,000 procedures performed globally.
How Hypoglossal Nerve Stimulation Works
The HGNS procedure involves the surgical implantation of a generator into the patient’s chest. Joseph Sinnott, an ear, nose and throat surgeon at GWH, explains that a lead is connected to the nerve responsible for moving the tongue forward. When activated, the device stimulates the nerve to ensure the airway remains open during every breath. Patients control the system using a small remote, similar in size to a computer mouse, which they activate each night before sleep.
Did you know?
The HGNS device is not a permanent “on” switch. Patients must manually activate the stimulation using their remote control every time they go to bed, giving them direct control over their treatment schedule.
Clinical Criteria and Patient Selection
Access to HGNS is currently restricted to specific clinical profiles. According to Sinnott, the treatment is not a first-line therapy. Surgeons prioritize CPAP for the majority of patients, reserving the implant for those who struggle significantly with conventional methods. In regions like Wiltshire, the criteria for inclusion remain “very strict,” with only a small number of patients approved for the surgery each month. The procedure is specifically targeted at “extreme cases” where other interventions have failed to mitigate the risks of sleep apnoea, such as daytime concentration difficulties and mood swings.
The Shift in Sleep Apnoea Management
While the treatment has seen widespread rollout across the United States and Europe, its integration into the UK healthcare system highlights the ongoing need for alternatives to CPAP. Patients like Turnbull, one of the first patients to receive the implant, have reported being “extremely grateful” for the option, citing it as a necessary step after being unable to tolerate traditional mask-based therapies.
Frequently Asked Questions
- What is the primary function of an HGNS device?
The device stimulates the nerve that pushes the tongue forward, preventing the airway from collapsing during sleep. - Is HGNS the first treatment option for sleep apnoea?
No. According to Joseph Sinnott, CPAP therapy remains the standard first-line treatment, with HGNS reserved for patients who cannot tolerate it. - How do patients turn the device on?
Patients use a small, handheld remote that resembles a computer mouse to activate the device each night. - Who is eligible for this surgery?
Eligibility is based on strict criteria, generally limited to “extreme cases” where standard treatments have proven ineffective.
Are you or a loved one struggling with CPAP intolerance? Speak with your GP or a sleep specialist to discuss whether you meet the clinical criteria for advanced surgical interventions. Explore our sleep health archive for more information on managing obstructive sleep apnoea.
