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Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis


Ratneswaran, Deeban; Guni, Ahmad; Pengo, Martino F; Al-Sherif, Miral; He, Baiting; Cheng, Michael C F; Steier, Joerg; Schwarz, Esther I (2020). Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis. Sleep & breathing = Schlaf & Atmung:Epub ahead of print.

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.

Keywords: Hypoglossal nerve stimulation; Obstructive sleep apnea; Transcutaneous electrical stimulation; Upper airway collapse

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.

Keywords: Hypoglossal nerve stimulation; Obstructive sleep apnea; Transcutaneous electrical stimulation; Upper airway collapse

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Otorhinolaryngology
Health Sciences > Neurology (clinical)
Uncontrolled Keywords:Otorhinolaryngology, Clinical Neurology
Language:English
Date:9 May 2020
Deposited On:08 Jan 2021 06:50
Last Modified:29 Jan 2021 07:03
Publisher:Springer
ISSN:1520-9512
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s11325-020-02069-2
PubMed ID:32388780
Project Information:
  • : FunderSNSF
  • : Grant ID1000-000001
  • : Project TitleSchlussband (Bd. VI) der Jacob Burckhardt-Biographie
  • : FunderSNSF
  • : Grant ID1000-000001
  • : Project TitleSchlussband (Bd. VI) der Jacob Burckhardt-Biographie

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