Emerging Therapies for Obstructive Sleep Apnea

Akinnusi, Morohunfolu E.; Saliba, Ranime; El-Solh, Ali

doi:10.1007/s00408-012-9380-1

Cited by 9 publications

(11 citation statements)

References 54 publications

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“…). The remaining 25 articles were retrieved for more detailed full‐text evaluation, and 19 were excluded for the following reasons: six studies were not original studies; eight studies did not provide sufficient clinical outcomes (AHI, ODI, and ESS), one study's polysomnography outcomes were reported in their previously published article, and four studies evaluated other electrical stimulation modalities (submental and intraoral stimulation). The final selection included six studies describing 200 patients, with a mean age of 53.9 ± 10.1 years and a follow‐up period ranging from 6 to 12 months (Table ).…”

Section: Resultsmentioning

confidence: 99%

Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta‐analysis

et al. 2014

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Section: Resultsmentioning

confidence: 99%

Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta‐analysis

et al. 2014

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“…In animal studies, exogenous electrical stimulation of the genioglossus muscle augmented the activity of this pharyngeal dilator and restored airway patency [11]. Moreover, several studies showed that electrical stimulation of the genioglossus may improve pharyngeal stability and prevent upper-airway collapse during sleep in patients with OSA, playing an important role in treatment [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Electrical Stimulation of the Genioglossus in Patients with Residual Obstructive Sleep Apnea Post-UPPP Surgery

YB¹,

Ding²

2015

Intern Med

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Objective: Genioglossus is a major upper-airway dilator muscle, which leads to upper-airway obstruction when its activity is decreased. We evaluated the effect and safety of genioglossus stimulation for patients with residual mild-to-moderate obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods:We enrolled 23 patients diagnosed with OSA by polysomnography (PSG) 6 months after UPPP, who underwent nightly transcutaneous genioglossus stimulation (TGS) therapy. Apnea hypopnea index (AHI), microarousal index (MAI), the ratio of duration of SpO2 < 90% to total sleep time (T90) and Epworth sleepiness scale (ESS) before and during TGS treatment were compared. We first observed the overall effect of TGS, and then compared its influence on patients with mild and moderate sleep apnea.Results: Compared with non-TGS therapy, there was a significant decrease in AHI, MAI, T90, and ESS (9.15 ± 4.21 vs. 17.90 ± 6.85, p < 0.0001; 6.33 ± 3.75 vs. 10.93 ± 4.90, p < 0.0001; 4.87 ± 4.02 vs. 9.13 ± 4.24, p < 0.0001; 8.65 ± 3.35 vs. 9.30 ± 3.10, p = 0.002, respectively), and a significant increase in mean SpO2 and minimal SpO2 (mini SpO2) (95.52% ± 0.95% vs. 94.43% ± 1.12%, p < 0.0001; 88.74% ± 2.94% vs. 85.17% ± 4.67%, p < 0.0001, respectively) during TGS treatment. Patients in the mild and moderate groups had the same variation trend between TGS and non-TGS therapy nights. However, the moderate group had a higher absolute value of changed AHI (AHI; 11.12 ± 3.95 vs. 5.66 ± 1.70, p < 0.05) and MAI (MAI; 5.8 (3.3, 8.6) vs. 2.5 (1.05, 5.6), p < 0.05) than the mild group. There were no significant differences in absolute changed mean SpO2 (mean SpO2), absolute changed miniSpO2 (miniSpO2), changed T90 (T90) and absolute changed ESS (ESS) between the two groups. Moreover, the percentage of AHI was not different between the two groups (47.89% ± 13.79% vs. 51.04% ± 13.32%, p = 0.587). There was no perceived discomfort during TGS therapy and no procedure-related adverse events. Conclusion:Submental transcutaneous electrical stimulation of the genioglossus led to a significant reduction in AHI and improvement of daytime sleepiness for existing mild-to-moderate OSA patient's post-UPPP surgery.

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“…La apnea obstructiva del sueño (AOS) es el trastorno respiratorio del sueño más frecuente en adultos y niños, y es considerado un problema de salud pública [1]. Se asocia con incremento del riesgo cardiovascular [2] y con disminución de la calidad de vida del paciente [3]. La AOS se caracteriza por obstrucciones recurrentes (parciales o totales) de la vía aérea superior (VAS) durante el sueño [4] que llevan a hipoxemia e hipercapnia [2] y a despertares nocturnos [5,6].…”

Section: Introductionunclassified

“…Se asocia con incremento del riesgo cardiovascular [2] y con disminución de la calidad de vida del paciente [3]. La AOS se caracteriza por obstrucciones recurrentes (parciales o totales) de la vía aérea superior (VAS) durante el sueño [4] que llevan a hipoxemia e hipercapnia [2] y a despertares nocturnos [5,6]. Su fisiopatología se basa en el incremento de la resistencia al flujo de aire dado por un colapso de la VAS durante el sueño, principalmente en la faringe [7].…”

Section: Introductionunclassified

“…No existe una terapia farmacológica eficaz para este trastorno [1], ya que no se comprende totalmente su etiología [9]. Desde la década de los ochenta [10], el pilar de tratamiento ha sido la presión positiva continua en la vía aérea (CPAP, por su sigla en inglés); sin embargo, se reporta adherencia inadecuada o rechazo de su uso [2] en el 40-50 % de los pacientes [11].…”

Section: Introductionunclassified

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Estimulación del nervio hipogloso: una nueva alternativa en el tratamiento de la apnea obstructiva del sueño

et al. 2014

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Introducción: la apnea obstructiva del sueño (AOS) es el trastorno respiratorio del sueño más frecuente. La terapia de elección es la presión positiva continua de la vía aérea (CPAP), pero se ha descrito mala adherencia en su uso. La estimulación del nervio hipogloso (ENH) se encuentra entre las nuevas modalidades de tratamiento en estudio.Objetivo: revisar la fisiopatología de este trastorno, así como la efectividad y seguridad de la ENH como terapia de la AOS.Metodología: se realizó una búsqueda en la base de datos de Medline utilizando las palabras clave: Sleep Apnea, Syndrome; Sleep Apnea, Obstructive; Hypoglossal Nerve; Electrodes, Implanted; Implantable Neurostimulators, y Electric Stimulation Therapy.Resultados: se encontraron 267 artículos, de los cuales se seleccionaron 27 según los criterios de inclusión y exclusión. Adicionalmente, se hizo una búsqueda secundaria de estos artículos. La ENH ha mostrado un perfil de efectividad y seguridad favorable con alta adherencia como tratamiento de la AOS. Sin embargo, no se recomienda en pacientes con un índice apnea-hipopnea > 50, ya que produce una reducción parcial, inferior que la que puede producir el CPAP.Conclusiones: la ENH ayuda a corregir, parcialmente, uno de los mecanismos fisiopatológicos de la AOS. Si bien en la revisión se encontraron datos que sugieren efectividad y seguridad aceptables en corto plazo, se necesitan más estudios sobre efectividad y seguridad a largo plazo, sobre comparación directa con CPAP en algunos casos y sobre uso bilateral de esta nueva modalidad terapéutica.

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Emerging Therapies for Obstructive Sleep Apnea

Cited by 9 publications

References 54 publications

Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta‐analysis

Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta‐analysis

Electrical Stimulation of the Genioglossus in Patients with Residual Obstructive Sleep Apnea Post-UPPP Surgery

Estimulación del nervio hipogloso: una nueva alternativa en el tratamiento de la apnea obstructiva del sueño

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