Abstract
Study objectivesWe aimed to determine whether bone-conducted acoustic stimulation could prematurely terminate sleep apnea events, thereby decreasing amplitude and duration of subsequent oxygen desaturation. As oxygen desaturation has been linked to cardiovascular consequences, we postulate this could be a viable therapy in some cases. MethodsEight patients with severe Obstructive Sleep Apnea (2 women, 45 [20–68] y.o. Apnea-Hypopnea Index: 77.7 ± 22.3/h) underwent polysomnography at the Lausanne University Sleep Center. Short acoustic stimulations were administered by bone conduction every second event of sleep apnea. Sounds were remotely administered using a Dreem® headband worn by patients while undergoing nocturnal polysomnography. Amplitude (%) and duration(s) of oxygen desaturations following terminated apneas were compared to that of non-stimulated previous and subsequent events. Results549 stimulations (68.6 ± 38 sounds per patient) in N1 (16.2%), N2 (69.9%), N3 (4.2%), and REM(9.6%) were conducted. Compared to the previous and subsequent non-stimulated apnea, stimulations reduced event duration by 21.4% (-3.4 ± 7.2 s, p < 0.0001) while oxygen desaturation amplitude and duration were reduced by 30.4% (mean absolute difference ± SD: −1.9 ± 2.8%, p < 0.0001), and 39.6% (-5.7 ± 9.2 s, p < 0.0001) respectively. For these variables, each patient showed a significant improvement following acoustic stimulation. Sound-associated discomfort was rated 1.14 ± 1.53 on an 8 points scale (8 = worst) and only 6.8% of emitted sounds were perceived by the patients, suggesting a well-tolerated intervention. ConclusionsBone-conducted sound stimuli decreased apnea events duration as well as duration and amplitude of associated oxygen desaturations. Stimulations were well tolerated and rarely perceived by patients. This therapeutic approach deserves further investigation, with monitoring of effects on sleep quality, daytime function/sleepiness and cardiovascular parameters.
Highlights
Obstructive Sleep Apnea (OSA) is a frequent condition inducing repetitive arousals from sleep and oxygen desaturations, which has been shown to be associated with daytime sleepiness, long-term risk of hypertension, stroke, heart failure, diabetes, metabolic syndrome and depression [1e9]
Analysis of 549 paired respiratory events across the 8 participants showed a 30.4% reduction in oxygen desaturation amplitude in stimulated events compared to the mean of previous and subsequent non-stimulated respiratory events
Desaturations' duration decreased by 39.6% (-5.7 ± 9.2s, p < 0.0001), the apneas’ duration by 21.4% (3.4 ± 7.2s, p < 0.0001) and the absolute nadir oxygen saturation increased by 1.66% ± 5.69% (p < 0.0001) with the sound stimulations
Summary
Obstructive Sleep Apnea (OSA) is a frequent condition inducing repetitive arousals from sleep and oxygen desaturations, which has been shown to be associated with daytime sleepiness, long-term risk of hypertension, stroke, heart failure, diabetes, metabolic syndrome and depression [1e9]. Arousals from sleep apnea induce sleepiness and transient nocturnal hypertension [10,11], oxygen desaturations in sleep apnea are the most consistent predictor of increased cardiovascular risk [12,13] suggesting that OSA treatments should aim primarily at reducing occurrence and amplitude of sleep apneaassociated oxygen desaturations. Since sleep apneas usually end with an arousal from sleep that allows breathing to resume, triggering an earlier awakening could decrease oxygen desaturations' severity by reducing apneas’ duration. The aim of this research was to determine if early termination of OSA could be generated by an arousal generated by boneconducted sound-stimulation, decreasing the amplitude and duration of oxygen desaturation
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