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Observation
February 14, 2019

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea

Author Affiliations
  • 1Division of Pulmonology Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Division of Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 4Department of Otolaryngology–Head and Neck Surgery, Cincinnati VA, Cincinnati, Ohio
JAMA Otolaryngol Head Neck Surg. 2019;145(4):389-390. doi:10.1001/jamaoto.2018.4077

The hypoglossal nerve stimulator (HNS) is approved for the treatment of obstructive sleep apnea (OSA) in patients who cannot tolerate positive airway pressure (PAP) therapy. Indications for implantation include an apnea-hypopnea index (AHI) of 15 to 65 events/h with central apneas constituting fewer than 25% of the AHI because it is assumed that HNS therapy will have no effect on central events. We present a patient whose OSA was inadequately controlled with PAP who underwent HNS as a salvage procedure despite not meeting these indications. After HNS implantation, the patient’s obstructive component was successfully treated but treatment-emergent central sleep apnea (CSA) was complicated by new-onset Cheyne-Stokes breathing (CSB). Ethical approval was obtained from the Cincinnati Veterans Affairs Medical Center.

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