IntroductionObstructive sleep apnoea (OSA) is characterised by a loss of neuromuscular tone of the upper airway dilator muscles while asleep. This study investigated the effectiveness of transcutaneous electrical stimulation in patients with OSA.Patients and methodsThis was a randomised, sham-controlled crossover trial using transcutaneous electrical stimulation of the upper airway dilator muscles in patients with confirmed OSA. Patients were randomly assigned to one night of sham stimulation and one night of active treatment. The primary outcome was the 4% oxygen desaturation index, responders were defined as patients with a reduction >25% in the oxygen desaturation index when compared with sham stimulation and/or with an index <5/hour in the active treatment night.ResultsIn 36 patients (age mean 50.8 (SD 11.2) years, male/female 30/6, body mass index median 29.6 (IQR 26.9–34.9) kg/m2, Epworth Sleepiness Scale 10.5 (4.6) points, oxygen desaturation index median 25.7 (16.0–49.1)/hour, apnoea-hypopnoea index median 28.1 (19.0–57.0)/hour) the primary outcome measure improved when comparing sham stimulation (median 26.9 (17.5–39.5)/hour) with active treatment (median 19.5 (11.6–40.0)/hour; p=0.026), a modest reduction of the mean by 4.1 (95% CI −0.6 to 8.9)/hour. Secondary outcome parameters of patients' perception indicated that stimulation was well tolerated. Responders (47.2%) were predominantly from the mild-to-moderate OSA category. In this subgroup, the oxygen desaturation index was reduced by 10.0 (95% CI 3.9 to 16.0)/hour (p<0.001) and the apnoea-hypopnoea index was reduced by 9.1 (95% CI 2.0 to 16.2)/hour (p=0.004).ConclusionTranscutaneous electrical stimulation of the pharyngeal dilators during a single night in patients with OSA improves upper airway obstruction and is well tolerated.Trial registration numberNCT01661712.
Obstructive sleep apnoea (OSA) is a common risk factor for cardiovascular disease. Continuous positive airway pressure (CPAP) improves OSA symptoms and blood pressure control. The effect of CPAP on blood pressure variability (BPV) in patients with and without hypertension treated with auto-titrating CPAP (APAP) for two weeks was studied. 78 participants (76.9%male, 49%hypertensive, mean body-mass-index (BMI) 36.2(6.9)kg/m 2 , age 49.0(12.9)years) underwent two weeks of APAP therapy. Office blood pressure (BP), blood pressure variability (BPV; standard deviation of three BP measurements) and pulse rate were measured before and after treatment.Systolic BPV (5.3±4.9 vs 4.2±3.4mmHg, p=0.047) and pulse rate (78.0±14.5 vs 75.5±15.8bpm, p=0.032) decreased after treatment, particularly in hypertensive participants. Mask leak was independently associated with reduced changes in systolic BPV (r=-0.237, p=0.048). Short-term APAP treatment reduced BPV and pulse rate, particularly in hypertensive patients with OSA.
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