Nasopharyngeal airway stenting devices for obstructive sleep apnoea: A systematic review and meta-analysis

Abstract

Objective: To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices.Methods: Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea-hypopnoea index, and sleep quality were collected.Results: Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Polysomnography data for patients treated with nasal trumpets as an isolated therapy were pooled for metaanalysis. The mean apnoea index ± standard deviation, for 53 patients, decreased from 32.4 ± 15.9 to 9.0 ± 7.2 episodes per hour ( p < 0.00001). The mean apnoea-hypopnoea index, for 193 patients, decreased from 44.1 ± 18.9 to 22.7 ± 19.3 episodes per hour ( p < 0.00001). The mean lowest oxygen saturation, for 193 patients, increased from 66.5 ± 14.2 to 75.5 ± 13.9 per cent ( p < 0.00001).Conclusion: Some studies have demonstrated limited effectiveness and low tolerability of nasopharyngeal airway stenting devices, while other studies have shown a significant benefit in treating obstructive sleep apnoea, with a high level of patient acceptance. Nasal trumpets have been successful in decreasing airway obstruction in the short term.

Pilot Study of a Nasal Airway Stent for the Treatment on Obstructive Sleep Apnea

“…Although we did not classified our patients in accordance to the Fujita classification, all subjects who showed ameliorated OSA and snoring by using the s-NAS would be classified in Fujita type I [22]. As we expected, on the basis of features of the s-NAS (length, structure, and design), the device was not effective in one subject with mild OSA and tonsillar hypertrophy and it was unable to normalize the AHI in severe OSA; these findings were consistent with those in previous studies of nasal and oral appliances [12,14,17,18]. Intriguingly, the device improved the number of apnea events, rather than the number of hypopnea events, in subjects with varying degrees of severity of OSA (Figure 2).…”

“…Some previous studies have reported oral or nasopharyngeal appliances as non-surgical alternatives to CPAP for OSA patients who do not tolerate CPAP treatment [12][13][14][15][16][17][18]. Although the concept of nasopharyngeal tube insertion to maintain airflow through the upper airway during sleep was proposed in the 1980s and has been reviewed before [7,12,18], such devices are not currently in common use. The nasal trumpet has been used successfully to decrease airway obstruction in the short term, such as immediately after surgery for OSA [18].…”

“…Although the concept of nasopharyngeal tube insertion to maintain airflow through the upper airway during sleep was proposed in the 1980s and has been reviewed before [7,12,18], such devices are not currently in common use. The nasal trumpet has been used successfully to decrease airway obstruction in the short term, such as immediately after surgery for OSA [18]. However, the stiffness, length, and consequent discomfort of nasal trumpets mean that they need to be improved for long-term tolerability [18].…”

“…The nasal trumpet has been used successfully to decrease airway obstruction in the short term, such as immediately after surgery for OSA [18]. However, the stiffness, length, and consequent discomfort of nasal trumpets mean that they need to be improved for long-term tolerability [18].…”

Reaching a wider audience

“…Kumar and colleagues review the evidence for the use of nasopharyngeal airway stenting devices in OSA patients. 5 In this respect, the evidence is mixed: some stenting devices have shown limited effectiveness and low tolerability, whereas others have shown significant benefit with high patient acceptability. Another article, by Acar and colleagues, investigates the effect of OSA on oral and dental health, 6 with the knowledge that open-mouth breathing can have an adverse effect.…”