Raj C Dedhia1,2, Amit J Shah3, Donald L Bliwise2, Arshed A Quyyumi4, Patrick J Strollo5, Qiao Li6,7, Giulia Da Poian6,7, Gari D Clifford6,7. 1. 1 Department of Otolaryngology, School of Medicine, Emory University, Atlanta, Georgia, USA. 2. 2 Emory Sleep Center, Emory Healthcare, Atlanta, Georgia, USA. 3. 3 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. 4. 4 Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA. 5. 5 Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 6. 6 Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA. 7. 7 Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.
Abstract
OBJECTIVE:Hypoglossal nerve stimulation represents a novel therapy for the treatment of moderate-severe obstructive sleep apnea; nonetheless, its cardiovascular effects are not known. We examine the effects of hypoglossal nerve stimulation on heart rate variability, a measure of autonomic function. STUDY DESIGN: Substudy of the STAR trial (Stimulation Therapy for Apnea Reduction): a multicenter prospective single-group cohort. SETTING:Academic and private practice centers in the United States and Europe. SUBJECTS AND METHODS: A subset of responder participants (n = 46) from the STAR trial was randomized to therapy withdrawal or therapy maintenance 12 months after surgery. Heart rate variability analysis included standard deviation of the R-R interval (SDNN), low-frequency power of the R-R interval, and high-frequency power of the R-R interval. Analysis was performed by sleep with 5-minute sliding window epochs during baseline, 12 months, and the maintenance/withdrawal period. RESULTS: A significant improvement from baseline to 12 months in heart rate variability was seen for SDNN and low frequency across all sleep stages. SDNN analysis demonstrated no change in the wake period (mean ± SD: 0.042 ± 0.01 vs 0.077 ± 0.07, P = .19). Reduction in SDNN was correlated to improvement in apnea-hypopnea index ( r = 0.39, P = .03). In the therapy withdrawal group, no significant changes in SDNN were seen for N1/N2, N3, or rapid eye movement sleep. CONCLUSION:Hypoglossal nerve stimulation therapy appears to reduce heart rate variability during sleep. This reduction was not affected by a 1-week withdrawal period. Larger prospective studies are required to better understand the effect of hypoglossal nerve stimulation on autonomic dysfunction in obstructive sleep apnea.
RCT Entities:
OBJECTIVE:Hypoglossal nerve stimulation represents a novel therapy for the treatment of moderate-severe obstructive sleep apnea; nonetheless, its cardiovascular effects are not known. We examine the effects of hypoglossal nerve stimulation on heart rate variability, a measure of autonomic function. STUDY DESIGN: Substudy of the STAR trial (Stimulation Therapy for Apnea Reduction): a multicenter prospective single-group cohort. SETTING: Academic and private practice centers in the United States and Europe. SUBJECTS AND METHODS: A subset of responder participants (n = 46) from the STAR trial was randomized to therapy withdrawal or therapy maintenance 12 months after surgery. Heart rate variability analysis included standard deviation of the R-R interval (SDNN), low-frequency power of the R-R interval, and high-frequency power of the R-R interval. Analysis was performed by sleep with 5-minute sliding window epochs during baseline, 12 months, and the maintenance/withdrawal period. RESULTS: A significant improvement from baseline to 12 months in heart rate variability was seen for SDNN and low frequency across all sleep stages. SDNN analysis demonstrated no change in the wake period (mean ± SD: 0.042 ± 0.01 vs 0.077 ± 0.07, P = .19). Reduction in SDNN was correlated to improvement in apnea-hypopnea index ( r = 0.39, P = .03). In the therapy withdrawal group, no significant changes in SDNN were seen for N1/N2, N3, or rapid eye movement sleep. CONCLUSION:Hypoglossal nerve stimulation therapy appears to reduce heart rate variability during sleep. This reduction was not affected by a 1-week withdrawal period. Larger prospective studies are required to better understand the effect of hypoglossal nerve stimulation on autonomic dysfunction in obstructive sleep apnea.
Authors: Saif Mashaqi; Salma Imran Patel; Daniel Combs; Lauren Estep; Sonia Helmick; Joan Machamer; Sairam Parthasarathy Journal: Int J Environ Res Public Health Date: 2021-02-09 Impact factor: 3.390
Authors: Reena Mehra; Olga A Tjurmina; Olujimi A Ajijola; Rishi Arora; Donald C Bolser; Mark W Chapleau; Peng-Sheng Chen; Colleen E Clancy; Brian P Delisle; Michael R Gold; Jeffrey J Goldberger; David S Goldstein; Beth A Habecker; M Louis Handoko; Robert Harvey; James P Hummel; Thomas Hund; Christian Meyer; Susan Redline; Crystal M Ripplinger; Marc A Simon; Virend K Somers; Stavros Stavrakis; Thomas Taylor-Clark; Bradley Joel Undem; Richard L Verrier; Irving H Zucker; George Sopko; Kalyanam Shivkumar Journal: JACC Basic Transl Sci Date: 2022-01-26
Authors: Armin Steffen; Clemens Heiser; Wolfgang Galetke; Simon-Dominik Herkenrath; Joachim T Maurer; Eck Günther; Boris A Stuck; Holger Woehrle; Jan Löhler; Winfried Randerath Journal: Eur Arch Otorhinolaryngol Date: 2021-06-21 Impact factor: 2.503