Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF

Hypoglossal nerve conduction studies in patients with obstructive sleep apnea

The Egyptian Journal of Otolaryngology volume 29, pages 176–181 (2013)Cite this article

En

Abstract

Aim of the work

To identify the correlation between obstructive sleep apnea (OSA) and motor nerve conduction study of hypoglossal nerve in terms of amplitude and terminal latency.

Patients and methods

The present study included 16 adult OSA patients who presented to the Otolaryngology outpatient clinic of the Suez Canal University Hospital. Exclusion criteria included previous significant facial trauma, head or neck cancer, previous surgery (including tonsillectomy or adenoidectomy), previous radiation therapy to head or neck, known diagnosis of peripheral neuropathy, any implanted device (nerve stimulator, implanted pump, pacemaker, and defibrillator), and known pregnancy. All patients were subjected to an assessment protocol that included thorough assessment of history (age, sex, snoring, nasal obstruction, and excessive daytime sleepiness), clinical examinations [BMI, apnea/hypopnea index (AHI), Friedman tongue position (FTP), and Mallampati grading], and electrophysiological studies of hypoglossal nerve.

Results

87.5% of the patients had moderate to severe AHI (15 to >30). The degree of excessive daytime sleepiness was slight in 18.8% of the patients, mild in 50% of the patients, and moderate in 31.3% of the patients. FTP grades ranged from grade II (FTP II) (37.5%) to grade III (FTP III) (62.5%). Mallampati grading of tonsils also ranged from grade 2 (T2) (43.8%) to grade 3 (T3) (56.2%). Seventy-five percent of the patients had delayed distal latency of hypoglossal nerve. The mean distal latency of the patients was 3.24±123 ms, with the range of 2.5–7.7 ms. All the patients had low motor amplitude of the hypoglossal nerve. There were significant positive correlations between excessive daytime sleepiness and BMI, snoring, FTP, Mallampati grading, and decreased hypoglossal nerve distal latency.

Conclusion

Most patients with OSA had significantly impaired hypoglossal nerve conduction in the form of delayed distal latency and low motor amplitude.

References

  1. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–2016.

    Article  CAS  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–1235.

    Article  CAS  Google Scholar 

  3. Finkelstein Y, Wexler D, Berger G, Nachmany A, Shapiro-Feinberg M, Ophir D. Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction. Arch Otolaryngol Head Neck Surg. 2000;126:593–600.

    Article  CAS  Google Scholar 

  4. Kimoff RJ. Upper airway myopathy is important in the pathophysiology of obstructive sleep apnea. J Clin Sleep Med. 2007;3:567–569.

    Article  Google Scholar 

  5. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–2041.

    Article  CAS  Google Scholar 

  6. Hattori C, Nishimura T, Kawakatsu K, Hayakawa M, Suzuki K. Comparison of surgery and nasal continuous positive airway pressure treatment for obstructive sleep apnea syndrome. Acta Otolaryngol Suppl. 2003;550:46–50.

    Article  Google Scholar 

  7. Randerath WJ, Galetke W, Domanski U, Weitkunat R, Ruhle K-H. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004;27:254–259.

    Article  Google Scholar 

  8. Eisele DW, Schwartz AR, Smith PL. Tongue neuromuscular and direct hypoglossal nerve stimulation for obstructive sleep apnea. Otolaryngol Clin North Am. 2003;36:501–510.

    Article  Google Scholar 

  9. World Health Organization (WHO). Measuring obesity-classification and description of anthropometrics data. Copenhagen:WHO Regional office for Europe;1989. pp. 12–17.

    Google Scholar 

  10. Ramchandren S, Gruis KL, Chervin RD, Lisabeth LD, Concannon M, Wolfe J, et al. Hypoglossal nerve conduction findings in obstructive sleep apnea. Muscle Nerve. 2010;42:257–261.

    Article  Google Scholar 

  11. Redmond MD, Di Benedetto M. Hypoglossal nerve conduction in normal subjects. Muscle Nerve. 1988;11:447–452.

    Article  CAS  Google Scholar 

  12. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javler F, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med. 2001;163:19–25.

    Article  CAS  Google Scholar 

  13. Svanborg E. Impact of obstructive apnea syndrome on upper airway respiratory muscles. Respir Physiol Neurobiol. 2005;147 Special Issue: 263–272.

    Article  Google Scholar 

  14. Boyd JH, Petrof BJ, Hamid Q, Fraser R, Kimoff RJ. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170:541–546.

    Article  Google Scholar 

  15. Eckert DJ, Saboisky JP, Jordan AS, Malhotra A. Upper airway myopathy is not important in the pathophysiology of obstructive sleep apnea. J Clin Sleep Med. 2007;3:570–573.

    Article  Google Scholar 

  16. Saboisky JP, Butler JE, McKenzie DK, Gorman RB, Trinder JA, White DP, Gandevia SC. Neural drive to human genioglossus in obstructive sleep apnoea. J Physiol. 2007;585:135–146.

    Article  CAS  Google Scholar 

  17. Carrera M, Barbé F, Sauleda J, Tomás M, Gómez C, Santos C, Agustí AGN. Effects of obesity upon genioglossus structure and function in obstructive sleep apnoea. Eur Respir J. 2004;23:425–429.

    Article  CAS  Google Scholar 

  18. Dahlin LB, Lundborg G. Vibration-induced hand problems: role of the peripheral nerves in the pathophysiology. Scand J Plast Reconstr Surg Hand Surg. 2001;35:225–232.

    Article  CAS  Google Scholar 

  19. Edstrom L, Larsson H, Larsson L. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. J Neurol Neurosurg Psychiatry. 1992;55:916–920.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

    Samy M. Ragab, Mohamed H. Bader El Din & Mohamed T. El Tabakh

  2. Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

    Mohamed A. Hefny

Authors
  1. Samy M. Ragab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed H. Bader El Din
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohamed A. Hefny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed T. El Tabakh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed T. El Tabakh.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ragab, S.M., El Din, M.H.B., Hefny, M.A. et al. Hypoglossal nerve conduction studies in patients with obstructive sleep apnea. Egypt J Otolaryngol 29, 176–181 (2013). https://doi.org/10.7123/01.EJO.0000429580.53516.08

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.7123/01.EJO.0000429580.53516.08

Keywords