Trachea Requirements for Tongue Stimulator (Hypoglossal Nerve Stimulation) in OSA
The trachea does not need to show any specific findings for hypoglossal nerve stimulation candidacy—this question appears to confuse tracheostomy (an outdated surgical procedure) with modern tongue stimulator therapy.
Key Clarification
The provided evidence discusses tracheostomy as a historical surgical intervention for OSA, not as a requirement for hypoglossal nerve stimulation (HNS). These are completely separate treatments:
- Tracheostomy was mentioned only in the context of obsolete surgical techniques like glossopexia, where patients required preoperative tracheotomy for tongue base surgeries 1
- Modern hypoglossal nerve stimulation does NOT require tracheostomy or any tracheal evaluation 2
Actual Anatomical Requirements for Hypoglossal Nerve Stimulation
The critical anatomical assessment occurs at the soft palate level via drug-induced sleep endoscopy (DISE), not the trachea:
- Absence of complete concentric collapse at the soft palate level is mandatory for HNS candidacy 2, 3
- Patients must demonstrate appropriate upper airway anatomy confirmed by DISE showing that collapse patterns are amenable to tongue advancement 2
- The hypoglossal nerve and genioglossus muscle must have structural integrity 4
Standard Patient Selection Criteria for HNS
The following criteria must be met, none involving the trachea:
- Age ≥18 years 2
- BMI <32-40 kg/m² (varies by guideline: Veterans Affairs uses <32, others use <40) 2
- AHI 15-65 to 15-100 events/hour (depending on guideline) 2
- Documented CPAP failure or intolerance 2
- Confirmed anatomical candidacy via DISE without complete concentric palatal collapse 2, 3
- Polysomnography performed within 24 months 2
Common Pitfall to Avoid
Do not confuse historical tongue base surgical procedures (which required tracheostomy for airway protection during recovery) with modern implantable hypoglossal nerve stimulation. The older glossopexia and lingualplasty procedures from the 1980s-1990s required tracheostomy and had severe complications including mediastinal infections 1. These techniques are no longer used and have no role in modern OSA management 1.