Transcutaneous Electrical Stimulation Therapy in Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis

Abstract

Objective To evaluate the treatment efficacy of transcutaneous electrical nerve stimulation (TENS) in patients with obstructive sleep apnea (OSA). Data Sources Primary studies were identified though PubMed, Scopus, OVID, and Cochrane Library. Review Methods Systematic review was conducted by querying databases for articles published through July 2019. The search identified randomized controlled trial, randomized comparison, or observational studies pertaining to TENS treatment for OSA. Meta-analysis was performed on pre- and posttreatment apnea-hypopnea index (AHI), mean oxygen saturation (SaO2), lowest oxygen saturation (LSAT), and arousal index (AI). Results Literature search identified 10 studies that reported sufficient outcome measures to be considered for analysis. A total of 198 patients were identified with a mean age of 50.9 years with a male to female ratio of 1.6:1. Average body mass index (BMI) of the cohort was 29.8 kg/m2. Treatment with TENS demonstrated reduction in AHI by 12.9 points (95% confidence interval, −22.3 to −3.43; P = .008). The mean differences in SaO2, LSAT, and AI did not reach statistical significance. Conclusion The TENS treatment of upper airway dilator muscles resulted in reduction of AHI in patients with OSA. However, its effects on SaO2, LSAT, and AI were equivocal. Its impact on patients’ quality of life could not be assessed due to heterogeneity in outcome measures. Future randomized controlled trials with generalizable standardized outcome measures are needed to assess the efficacy and compliance of TENS.

Treatment options in obstructive sleep apnea

“…A recent study identified the physiological traits predictive of a good response to treatment: a low arousal threshold and loop gain, and occurrence of muscle compensation [59]. The HSN treatment has revived interest in transcutaneous electrical stimulation, which would have the advantage of eliminating surgery, but is less effective than HSN [60,61].…”

Novel avenues to approach non-CPAP therapy and implement comprehensive obstructive sleep apnoea care

“…"training" the tongue muscles), such stimulation results in an improvement in post-treatment AHI. However, the impact on quality of life remains unclear [174]. Electrical stimulation has also been applied to the muscles of the tongue to cause muscle contraction and increase strength and fatigue resistance and has been shown to reduce time spent snoring [175].…”

Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review

“…Two adhesive electrode patches were placed onto the skin of the submental area which is halfway between the chin and the angle of the mental region. With a little battery power, transcutaneous electrical stimulation was delivered to the submental skin to activate the motor unit of the dilators of the upper airway by stimulating the underlying nerve [ 123 ]. In a randomized, sham-controlled trial, the mean AHI after one-night transcutaneous electrical stimulation was reduced by 9.1 from 28.1 while the sham stimulation had a modest reduction of AHI by 4.1 from 19.5 [ 124 ].…”

“…TES showed less treatment efficiency than HGNS, but it was much more cost-effective and had almost no adverse events besides minor local skin irritation. TES had a similar stimulation methodology with HGNS that it would be used for predicting the treatment success of HGNS in patients with OSA before undergoing an invasive surgery [ 123 ]. Moreover, the TES is a non-invasive therapy that avoids complex surgical procedures, and the proof-of-concept outcome for patients with OSA is promising, even it has not been implemented into clinical management yet.…”