Deeban Ratneswaran1, Ahmad Guni2, Martino F Pengo3, Miral Al-Sherif4,2, Baiting He4, Michael Cf Cheng4, Joerg Steier4,2, Esther I Schwarz5,6. 1. Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, SE1 7EH, UK. deeban.ratneswaran@gstt.nhs.uk. 2. Faculty of Life Sciences and Medicine, King's College, London, UK. 3. Department of Cardiovascular, Sleep Disorder Centre, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy. 4. Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, SE1 7EH, UK. 5. Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy's and St Thomas' Hospital NHS Foundation Trust, London, SE1 7EH, UK. estherirene.schwarz@usz.ch. 6. Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, 8091, Zurich, Switzerland. estherirene.schwarz@usz.ch.
Abstract
PURPOSE: Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. METHODS: A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by I2 and τ2, respectively. RESULTS: Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/m2) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by - 24.9 h-1 [95%CI - 28.5, - 21.2] in HNS (χ2 79%, I2 82%) and by - 16.5 h-1 [95%CI - 25.1, - 7.8] in TES (χ2 7%, I2 43%; both p < 0.001). The ESS was reduced by - 5.0 (95%CI - 5.9, - 4.1) (p < 0.001). CONCLUSION: Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
PURPOSE: Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. METHODS: A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by I2 and τ2, respectively. RESULTS: Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/m2) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by - 24.9 h-1 [95%CI - 28.5, - 21.2] in HNS (χ2 79%, I2 82%) and by - 16.5 h-1 [95%CI - 25.1, - 7.8] in TES (χ2 7%, I2 43%; both p < 0.001). The ESS was reduced by - 5.0 (95%CI - 5.9, - 4.1) (p < 0.001). CONCLUSION: Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
Authors: Peter R Eastwood; Maree Barnes; Jennifer H Walsh; Kathleen J Maddison; Geoffrey Hee; Alan R Schwartz; Philip L Smith; Atul Malhotra; R Douglas McEvoy; John R Wheatley; Fergal J O'Donoghue; Peter D Rochford; Tom Churchward; Matthew C Campbell; Carsten E Palme; Sam Robinson; George S Goding; Danny J Eckert; Amy S Jordan; Peter G Catcheside; Louise Tyler; Nick A Antic; Christopher J Worsnop; Eric J Kezirian; David R Hillman Journal: Sleep Date: 2011-11-01 Impact factor: 5.849
Authors: A R Schwartz; M L Bennett; P L Smith; W De Backer; J Hedner; A Boudewyns; P Van de Heyning; H Ejnell; W Hochban; L Knaack; T Podszus; T Penzel; J H Peter; G S Goding; D J Erickson; R Testerman; F Ottenhoff; D W Eisele Journal: Arch Otolaryngol Head Neck Surg Date: 2001-10
Authors: Ruth L B Ellen; Shawn C Marshall; Mark Palayew; Frank J Molnar; Keith G Wilson; Malcolm Man-Son-Hing Journal: J Clin Sleep Med Date: 2006-04-15 Impact factor: 4.062
Authors: Winfried Randerath; Jan de Lange; Jan Hedner; Jean Pierre T F Ho; Marie Marklund; Sofia Schiza; Jörg Steier; Johan Verbraecken Journal: ERJ Open Res Date: 2022-06-27
Authors: William D Moscoso-Barrera; Elena Urrestarazu; Manuel Alegre; Alejandro Horrillo-Maysonnial; Luis Fernando Urrea; Luis Mauricio Agudelo-Otalora; Luis F Giraldo-Cadavid; Secundino Fernández; Javier Burguete Journal: Int J Environ Res Public Health Date: 2022-06-06 Impact factor: 4.614