Electrical stimulation for the treatment of obstructive sleep apnoea: a review of the evidence

Bisogni, Valeria; Pengo, Martino F.; Vito, Andrea De; Maiolino, Giuseppe; Rossi, Gian Paolo; Moxham, John; Steier, Joerg

doi:10.1080/17476348.2017.1358619

Cited by 23 publications

(26 citation statements)

References 80 publications

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“…Interface-related problems were reduced when patients used BPAP and did not impact adherence to the same extent as with CPAP. CPAP is the first-line therapy for moderate-severe OSA but second-line alternatives such as MAD for mild OSA, BPAP for moderate-severe OSA (with significant co-morbidity) and, experimentally, the use of electrical stimulation need to be considered when first-line therapy is not successfully employed 12 to address specific features of the phenotypically different OSA patients. 21 Previous studies have shown that BPAP and CPAP therapies can achieve similar efficacy in controlling OSA, 17,22 but these studies did not focus on patients requiring high pressures to achieve control of OSA.…”

Section: Discussionmentioning

confidence: 99%

“…We investigated whether bilevel positive airway pressure (BPAP) could be an effective second-line therapy in this cohort of patients and found that BPAP significantly improved adherence and symptom control when compared to CPAP. specialist treatment should include assessment and guidance of suitable patients through an established treatment algorithm 12 to select the best second-line therapy if CPAP is not tolerated.…”

Section: Summary At a Glancementioning

confidence: 99%

“…Therapeutic alternatives might include mandibular advancement devices (MAD), otolaryngology (ENT; ear, nose and throat surgery) and maxillofacial surgery, and, in experimental/audit settings, hypoglossal nerve stimulation and transcutaneous electrical stimulation of the upper airway dilator muscles . Evidence‐based practice is currently developing and specialist treatment should include assessment and guidance of suitable patients through an established treatment algorithm to select the best second‐line therapy if CPAP is not tolerated.…”

Section: Introductionmentioning

confidence: 99%

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BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

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Background and objective Continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnoea (OSA), but many patients fail long‐term therapy. Bilevel positive airway pressure (BPAP) is a potential alternative. We hypothesized that BPAP could improve treatment adherence and outcomes in patients who cannot tolerate CPAP. Methods Patients with OSA who failed CPAP (usage < 4 h/day) and were referred to a tertiary sleep centre between 2014 and 2017 for BPAP were included. Age, gender, body mass index (BMI), co‐morbidities, CPAP use and reasons for failure, Epworth Sleepiness Scale (ESS), sleep study data, spirometry data and average maximum nightly compliance were recorded. Results A total of 52 patients with OSA requiring CPAP > 15 cm H2O (71% male, age: 58 (15) years, BMI: 42.6 (10.1) kg/m2, apnoea–hypopnoea index (AHI): 51.1 (30.4)/h) were studied; 62% had respiratory co‐morbidities affecting nocturnal breathing including obesity hypoventilation syndrome and COPD; 25% had neuromuscular conditions; and 17% had cardiovascular disease. CPAP was used for 199 (106–477) days prior to referral for BPAP. Reasons for CPAP failure were intolerant pressures (23%), uncontrolled symptoms (23%), mask problems (21%), adverse effects (13%), claustrophobia (8%), co‐morbidities (8%) and other issues (4%). Lower expiratory positive airway pressures were needed with BPAP compared to CPAP (10 (8–12) vs 16.8 (15.7–19.2) cm H2O, P = 0.001); patients achieved better adherence to BPAP (7.0 (4.0–8.5) vs 2.5 (1.6–6.7) h/night, P = 0.028) and better symptom control (ESS: 4.0 (1.0–7.0) vs 10.0 (6.0–17.0) points, P = 0.039). Conclusion In patients with moderate–severe OSA who fail CPAP therapy due to low adherence, BPAP is well tolerated and achieves sufficient control of sleep‐disordered breathing and its symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Summary At a Glancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

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“…82 Although some contradictory results have been published in the past, the last evidences are promising in terms of treatment efficacy and tolerability. 83 In the future, new technical advances and the device refinement are expected in order to better define the role of the transcutaneous stimulation in the treatment of OSA.…”

Section: Future Developments: Transcutaneous Nerve Stimulationmentioning

confidence: 99%

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Baptista¹,

Costantino²,

Moffa³

et al. 2020

NSS

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Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m 2 , collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine.

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“…Different approaches to use electrical stimulation to activate the upper airway dilator muscles have been reported to enhance airway patency in OSA (51)(52)(53)(54)(55). Pengo et al investigated the impact and feasibility of overnight bilateral submental transcutaneous electrical stimulation in OSA in the first randomised sham-controlled double-blind trial in 36 patients [mean age 50.8 (SD ±11.2) years, 83.3% male, median BMI 29.6 (IQR 26.9-34.9) kg/m 2 , ESS score 10.5 (4.6) points, ODI median 25.7 (IQR 16.0-49.1)/hour and AHI median 28.1 (IQR 19.0-57.0)] (54).…”

Section: Transcutaneous Electrical Stimulation/hypoglossal Nerve Stimmentioning

confidence: 99%

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Ratneswaran¹,

Sagoo²,

Steier³

2018

J. Thorac. Dis.

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Sleep medicine remains an exciting and fast-evolving field of medicine with insomnia, hypersomnia, parasomnia, sleepdisordered breathing and circadian rhythm disorders affecting significant proportions of the population. This update provides a selected overview about recent publications in the field. Sleep-disordered breathing and comorbidities The high prevalence of obstructive sleep apnoea (OSA) differs between genders, with male patients being more affected (1). In a US-nationwide study of 1,704,905 patients who had a diagnosis of OSA and 1,704,417 controls matched for age, sex and state of residence, the prevalence of co-morbidities [OR (95% CI)], such as type 2 diabetes [2.29 (2.28-2.31)], cardiac arrhythmia [3.26 (3.20-3.32)], ischaemic heart disease [2.54 (2.51-2.56)], stroke [3.51 (3.42-3.60)], hypertension [2.14 (2.13-2.15)], depression [4.99 (4.91-5.07)] and congestive heart failure [4.30 (4.21-4.39)] was increased (2). Non-communicable disease is important (3) and its link with comorbidities, predominantly its association with obesity (1), make OSA an important confounding factor that impacts on physical, social and mental health (4). Diagnostic criteria for sleep apnoea There have been ongoing discussions about the classification and diagnostic parameters of OSA. Study outcomes investigating OSA are dependent on accurate description, definition and comparisons of their patient groups. Heinzer et al. argue that the present International Classification of Sleep Disorders (ICSD-3) definition of sleep apnoea yields an unrealistically high prevalence of OSA (5), in part related to a low apnoea-hypopnoea index (AHI) threshold for normal subjects (5/h) and a high prevalence of coexisting symptoms and conditions such as fatigue, insomnia and hypertension which may not be related to the underlying OSA (6). In a group of 2,121 patients who underwent full home polysomnography (PSG) ['HypnoLaus' cohort; 48% male, median age 57, (interquartile range, IQR 49-68) years, mean body mass index (BMI) 25.6 kg/m 2 , standard deviation (SD) 4.1 kg/m 2 ], they applied the 2013 American Academy of Sleep Medicine (AASM) criteria for OSA: An apnoea was defined as ≥90% reduction in airflow from baseline, lasting for ≥10 seconds; a hypopnea was defined as ≥30% reduction in airflow from baseline, lasting for ≥10 seconds with either a ≥3% drop in oxygen saturation or an arousal (7,8). These criteria led to a diagnosis of moderate-to-severe OSA (sOSA) (AHI ≥15/h) in 23.4% (95% CI: 20.9-26.0) of women and 49.7% (95% CI: 46.6-52.8) of men (9). However, analysing the same cohort in 2016, but using the ICSD-3 criteria which are defined by an AHI ≥15/hour, or an AHI ≥5/hour associated with one or more symptoms of OSA or cardiovascular and metabolic comorbidities, the prevalence of OSA increased to 74.7% of men, and 52.1% of women (5,6,10). The authors suggested that a better definition of OSA should be sought using prospective and large cohort follow-up studies. Screening for OSA in a bariatric population OSA and obesity commonly co-exi...

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Electrical stimulation for the treatment of obstructive sleep apnoea: a review of the evidence

Cited by 23 publications

References 80 publications

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

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