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    Hypoglossal nerve implant vs CPAP

    Medically reviewed by Dr. Iván Méndez-Benegassi Silva · ENT & Sleep Medicine Specialist · HM Hospitales, Madrid · License No. 282855946

    Last reviewed:
    Hypoglossal nerve implant models compared: Inspire (chest neurostimulator) vs Nyxoah (under-chin)

    CPAP is the gold standard for sleep apnea, but many patients cannot live with the mask. The hypoglossal nerve implant — a "pacemaker for the tongue" — is the most advanced surgical alternative for selected patients. Here is how they really compare.

    CPAP
    Hypoglossal implant
    How it works
    A mask blows pressurized air all night to keep the airway open.
    An implant gently stimulates the tongue nerve with each breath, moving it forward.
    What you wear
    Mask, hose and machine every night.
    Nothing external; you turn it on with a remote before sleeping.
    Best for
    Any severity; first-line, non-surgical.
    Moderate-to-severe apnea in patients who cannot tolerate CPAP.
    Main limitation
    Up to half of patients abandon it (mask, noise, dryness).
    Surgery; not suitable if DISE shows complete concentric collapse.
    Reversible
    Yes, stop any night.
    It is a surgical device, though it can be switched off.

    The DISE decides candidacy

    The implant is not for everyone with apnea. A drug-induced sleep endoscopy (DISE) must confirm the collapse pattern: if the throat closes in a complete concentric ring, the implant will not work and we choose another path. This selection is exactly what makes results reliable.

    Who fits: the numbers

    The implant is reserved for moderate-to-severe apnea in well-selected patients. The usual criteria are:

    • ·Apnea-hypopnea index (AHI) between 15 and 65 events per hour.
    • ·Body-mass index (BMI) under 32: in higher BMI the bulkier tongue and throat respond worse.
    • ·Documented CPAP intolerance or failure.
    • ·A DISE that rules out complete concentric collapse.

    Two models, two designs

    Not all hypoglossal implants are built the same. Where the stimulator sits depends on the model:

    Inspire: a complete implant. A pulse generator is placed under the skin of the chest (below the collarbone), connected to a cuff on the hypoglossal nerve. You switch it on each night with a handheld remote.

    Nyxoah Genio: the implanted chip carries no battery. It is powered each night by a small external disposable patch worn under the chin — nothing is implanted in the chest.

    Who is each one for?

    CPAP first if you tolerate it: it is non-surgical, works at any severity and is reversible every night.

    Hypoglossal implant if you cannot tolerate CPAP, have moderate-to-severe apnea and the DISE confirms a suitable collapse pattern.

    Not a candidate for the implant? There are other surgical and conservative options — see the CPAP alternatives guide.

    Want to know if the implant fits your case? It starts with a sleep study and a DISE.

    See the specialistAbout the implantCPAP alternatives