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अमूर्त

Therapy for Obstructive Sleep Apnea Using Hypoglossal Nerve Stimulation

Yamaguchi Mosako*, Kato Yamaha

Sleep apnoea affects almost one billion people worldwide. Moderate to severe forms of Obstructive Sleep Apnoea (OSA) are associated with an increased risk of cardiovascular and cerebrovascular diseases. Sleep apnoea syndromes are characterized by breathing cessation during sleep. Such hypopnea or apnoeic episodes that last for at least 10 seconds lead to generalized hypoxemia, which not only negatively affects the cardiovascular and neurological systems but also has long-term consequences, including global respiratory failure. Although these episodes do not last for more than 30-50 seconds, it is inevitable that global respiratory failure will develop. Such episodes activate the sympathetic system, creating an undesirable flight-or-fight state, which has negative effects on the sleep cycle. Repetition of these sympathetic states also contributes to nocturnal hypertension, which progresses to essential therapy-resistant hypertension. Consequently, sleep apnoea shortens the estimated average lifespan due to an increased risk of strokes and acute myocardial infarction. Despite the available therapeutic options, including positive pressure ventilation and surgeries, there are no cures or optimal therapeutic options for the prevention of complications. Therefore, the development of new therapies is essential. 

The current first-line therapeutic option is a Continuous Positive Airway Pressure (CPAP) machine. Although CPAP has been proven to be a successful treatment for many patients, the issue is patients’ lack of adherence to the therapy. Surgical and conservative treatment options are also available. However, the effectiveness of such therapies has not been proven to be better. A relatively new therapeutic option, Hypoglossal Nerve Stimulation (HNS), is now available. This is a minor surgical intervention in which a pacemaker is inserted to control breathing when apnoea–hypopnea episodes occur. HNS may be the next standard therapeutic option for select patients suffering from OSA. In this article, we systematically reviewed articles addressing OSA, CPAP, and HNS. We discuss the effectiveness of HNS therapy on the Apnoea–Hypopnea Index (AHI), BMI, and systolic blood pressure. We also include the advantages and disadvantages of the therapeutic options currently available for OSA treatment.