Electrical Stimulation of the Genioglossus in Patients with Residual Obstructive Sleep Apnea Post-UPPP Surgery

Dong Yb,Ding N

doi:10.4172/2165-8048.1000216

Abstract

Objective: Genioglossus is a major upper-airway dilator muscle, which leads to upper-airway obstruction when its activity is decreased. We evaluated the effect and safety of genioglossus stimulation for patients with residual mild-to-moderate obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods: We enrolled 23 patients diagnosed with OSA by polysomnography (PSG) 6 months after UPPP, who underwent nightly transcutaneous genioglossus stimulation (TGS) therapy. Apnea hypopnea index (AHI), microarousal index (MAI), the ratio of duration of SpO2 < 90% to total sleep time (T90) and Epworth sleepiness scale (ESS) before and during TGS treatment were compared. We first observed the overall effect of TGS, and then compared its influence on patients with mild and moderate sleep apnea. Results: Compared with non-TGS therapy, there was a significant decrease in AHI, MAI, T90, and ESS (9.15 ± 4.21 vs. 17.90 ± 6.85, p < 0.0001; 6.33 ± 3.75 vs. 10.93 ± 4.90, p < 0.0001; 4.87 ± 4.02 vs. 9.13 ± 4.24, p < 0.0001; 8.65 ± 3.35 vs. 9.30 ± 3.10, p = 0.002, respectively), and a significant increase in mean SpO2 and minimal SpO2 (mini SpO2) (95.52% ± 0.95% vs. 94.43% ± 1.12%, p < 0.0001; 88.74% ± 2.94% vs. 85.17% ± 4.67%, p < 0.0001, respectively) during TGS treatment. Patients in the mild and moderate groups had the same variation trend between TGS and non-TGS therapy nights. However, the moderate group had a higher absolute value of changed AHI (â³AHI; 11.12 ± 3.95 vs. 5.66 ± 1.70, p < 0.05) and MAI (â³MAI; 5.8 (3.3, 8.6) vs. 2.5 (1.05, 5.6), p < 0.05) than the mild group. There were no significant differences in absolute changed mean SpO2 (â³mean SpO2), absolute changed miniSpO2 (â³miniSpO2), changed T90 (â³T90) and absolute changed ESS (â³ESS) between the two groups. Moreover, the percentage of â³AHI was not different between the two groups (47.89% ± 13.79% vs. 51.04% ± 13.32%, p = 0.587). There was no perceived discomfort during TGS therapy and no procedure-related adverse events. Conclusion: Submental transcutaneous electrical stimulation of the genioglossus led to a significant reduction in AHI and improvement of daytime sleepiness for existing mild-to-moderate OSA patient’s post-UPPP surgery.

Highlights

Obstructive sleep apnea syndrome (OSAS) is a common health disorder, affecting approximately 4% of men and 2% of women [1]
Compared with non-transcutaneous genioglossus stimulation (TGS) therapy, there was a significant decrease in Apnea hypopnea index (AHI), microarousal index (MAI), T90, and Epworth sleepiness scale (ESS) (9.15 ± 4.21 vs. 17.90 ± 6.85, p < 0.0001; 6.33 ± 3.75 vs. 10.93 ± 4.90, p < 0.0001; 4.87 ± 4.02 vs. 9.13 ± 4.24, p < 0.0001; 8.65 ± 3.35 vs. 9.30 ± 3.10, p = 0.002, respectively), and a significant increase in mean SpO2 and minimal SpO2 (95.52% ± 0.95% vs. 94.43% ± 1.12%, p < 0.0001; 88.74% ± 2.94% vs. 85.17% ± 4.67%, p < 0.0001, respectively) during TGS treatment
Submental transcutaneous electrical stimulation of the genioglossus led to a significant reduction in AHI and improvement of daytime sleepiness for existing mild-to-moderate obstructive sleep apnea (OSA) patient’s post-UPPP surgery

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) is a common health disorder, affecting approximately 4% of men and 2% of women [1]. It is characterized by repeated upper airway collapse due to loss of pharyngeal muscle tone, leading to intermittent oxyhemoglobin desaturations and arousals from sleep. Evidence suggests that intermittent hypoxemia and sleep disruption contribute to sudden cardiac death, stroke, hypertension, and metabolic dysregulation (nonalcoholic fatty liver disease glucose intolerance and hyperlipidemia) [2,3]. Continuous positive airway pressure (CPAP) is the most effective treatment for OSAS; many patients are inadequately treated owing to poorly tolerated CPAP. Patients were exposed to a significantly increased risk of cardiovascular and metabolic disease with no effective therapy. Further research is required to explore new therapeutic options for these patients

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Discussion

Conclusion