Hypoglossal Nerve Stimulator Implantation for Sleep Apnea Gains Popularity
The Inspire device consists of a stimulating cuff that is implanted in the neck and a battery that is placed in the chest. Courtesy of Columbia Surgery
By Adam Peterson
The Columbia sleep surgery program is helping more patients achieve quality sleep, thanks to an implantable technology that keeps the tongue from getting in the way of a good night’s rest. Inspire therapy is the first Food and Drug Administration (FDA)-approved device to treat moderate to severe obstructive sleep apnea (OSA) using hypoglossal nerve stimulation. “It’s essentially a pacemaker for the tongue,” says Yi Cai, MD, assistant professor and director of sleep surgery.
“Because it’s an implanted therapy, it can be much easier to manage than other common treatment options.” First approved in 2014, Inspire has been gaining popularity as a viable alternative to continuous positive airway pressure (CPAP). The latest model is significantly smaller and more streamlined, making it easier to implant and tolerate.
A Vital Need
For people with OSA, the tongue falls back during sleep, blocking the airway. In addition to causing snoring, the blockage restricts oxygen flow to the brain, periodically triggering the body to wake up and breathe.
Because this cycle happens repeatedly throughout the night, people with OSA have difficulty getting quality sleep. They often experience daytime fatigue, irritability, forgetfulness, or inability to concentrate. Over time, OSA increases the risk of high blood pressure, congestive heart failure, stroke, heart attack, metabolic disease, and dementia.
OSA affects millions of Americans; studies suggest that as many as 84 million adults in the United States live with this condition, with most cases going undiagnosed.
The Status Quo
Ironically, the most common treatment for sleep apnea may contribute to poor sleep quality in some patients. CPAP requires a patient to wear a mask over their nose and/or mouth. The mask is connected by a hose to a machine that creates a pressurized column of air that keeps the airway open during sleep.
Unsurprisingly, many people find this arrangement awkward and difficult to use.
“CPAP can work for some people, but it can be very uncomfortable for others,” says Dr. Cai. “Half of the people trying CPAP ultimately can’t use it as a long-term solution. In fact, patients must have tried and failed CPAP to be a candidate for Inspire.”
A Different Approach
The Inspire device consists of a stimulating cuff that is implanted in the neck and a battery that is placed in the chest. The device is controlled by an external remote and delivers gentle pulses to the tongue and airway muscles to keep the airway open. Data sent to an app allow the care team to monitor device performance and refine the treatment over time.
“It’s a same-day procedure that takes about two hours, including anesthesia time, and people usually report some soreness at the incision sites afterwards for a week or two,” says Dr. Cai. “It’s a simple and relatively low-pain recovery compared to other procedures in the field.”
In addition to having tried and failed CPAP, patients must have a body mass index of less than 40 and undergo a sleep endoscopy, a sedated exam that allows the surgical team to see how the airway collapses.
“If it collapses in a circular pattern, then they’re not a candidate for Inspire,” says Dr. Cai. “They also need a sleep study showing that they have moderate to severe sleep apnea. This isn’t for mild cases.”
Expanding Options
The therapy class for hypoglossal nerve stimulation is growing. A second device that delivers bilateral therapy and does not require an implanted battery, the Genio, was approved by the FDA in August 2025. Meanwhile, a third device, the aura6000, received premarket approval in March. Patients will soon have more treatment options than ever.
“So many of my patients report that they can function much better in life because of this device,” says Dr. Cai. “When I first meet them, they’re falling asleep in the waiting area or even falling asleep when we’re about to perform a sleep endoscopy; they’re falling asleep before we’re putting them to sleep! So I’d love to spread awareness that there are other options beyond CPAP. For so many people, we’re able to fix this issue for them.”
For more information, contact the Columbia sleep surgery program at sleepsurgery@cumc.columbia.edu or 646-317-3176.