Saturday, February 8, 2014

Research Highlights: Upper-Airway Stimulation Devices May Be an Effective Treatment for Obstructive Sleep Apnea

Upper-Airway Stimulation Devices May Be an Effective Treatment for Obstructive Sleep Apnea

The New England Journal of Medicine (NEJM) recently published a study investigating the efficacy of upper-airway stimulation as a treatment for obstructive sleep apnea. Obstructive sleep apnea is a disorder in which one’s upper airways are narrowed or closed during sleep. It is common, often resulting in extreme fatigue and reduced quality of life. Moderate to severe obstructive sleep apnea may have heightened risks, including vascular disease and even death. A popular current treatment for obstructive sleep apnea is the CPAP mask, which can effectively combat airway closures at night but is entirely reliant on patient adherence to treatment. Since many individuals struggle to maintain their treatments themselves, it is important to develop new treatments, such as upper-airway stimulation, that do not rely on patient adherence
126 individuals with moderate to severe sleep apnea who struggled to adhere to the CPAP treatment participated in this study. Experimenters excluded individuals with sever neuromuscular, pulmonary or heart diseases as well as those with other sleep conditions unrelated to sleep apnea. Experimenters surgically implanted an upper-airway stimulation device into the participants and then monitored how many episodes of sleep apnea the participants experienced each night over a period of 12 months.
Though this study was conducted with many safety precautions, two participants experienced adverse effects due to complications involving the surgically implanted device. Some other participants suffered from minor side effects such as tongue weakness, sore throat, and pain at the incision site, but these adverse effects were not considered serious and were generally resolved by making small adjustments to the implanted devices.
Despite these surgical complications, the implanted device showed evidence of being an effective treatment.  After 12 months, researchers found that the participants had experienced 68-70% fewer sleep apnea episodes per hour. Participants also rated significantly better on the FOSQ and Epworth Sleepiness Scale, indicating that they were far less fatigued than they had been prior to the treatment. In an additional withdrawal trial, 23 randomly selected participants had their devices switched off for one week and experienced a sharp increase in episodes of sleep apnea, strongly suggesting that the upper-airway stimulation device was the direct cause of their prior decrease in sleep apnea episodes. Though more experiments are needed to determine the safety and efficacy of this device, upper-airway stimulation has thus far shown evidence of being a powerful new treatment for obstructive sleep apnea, especially for those who struggle to adhere to the CPAP treatment.

NEJM 2014; 370:139-149


Caroline Russell-Troutman is the 2013-2014 Research Highlights Editor
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