Skip to main content

Advertisement

Log in

Effects of upper-airway stimulation on sleep architecture in patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Selective upper-airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the post-implantation polysomnography in UAS in patients with OSA.

Methods

Twenty-six patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated 2 and 3 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth sleepiness score (ESS), arousal parameter, and sleep patterns.

Results

The mean age was 60.2 years, 25 patients were male, 1 patient was female. Mean BMI was 29.0 kg/m2. The mean pre-implantation AHI of 33.9/h could be reduced to 9.1/h at 2 months post-implantation (p < 0.001). The amount of time spent in N1-sleep could be reduced from 23.2% at baseline to 16.0% at month 3 post-implantation. The amount of time spent in N2- and N3-sleep did not change during the observation period. A significant increase of the amount of REM sleep at month 2 (15.7%) compared to baseline (9.5%; p = 0.010) could be observed. A reduction of the number of arousals and the arousal index could be observed.

Conclusion

In conclusion, significant changes in sleep architecture of patients with OSA and sufficient treatment with UAS could be observed. A reduction of the amount of time spent in N1-sleep could be caused by treatment with UAS and the rebound of REM sleep, observed for the first time in a study on UAS, is also a potential marker of the efficacy of UAS on sleep architecture.

Trial registration

NCT02293746.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pengo MF, Steier J (2015) Emerging technology: electrical stimulation in obstructive sleep apnoea. J Thorac Dis 7:1286–1297

    PubMed  PubMed Central  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    Article  PubMed  PubMed Central  Google Scholar 

  4. Steier J, Martin A, Harris J, Jarrold I, Pugh D, Williams A (2014) Predicted relative prevalence estimates for obstructive sleep apnoea and the associated healthcare provision across the UK. Thorax 69:390–392

    Article  PubMed  Google Scholar 

  5. Strollo PJ, Rogers RM (1996) Obstructive sleep apnea. N Engl J Med 334:99–104

    Article  PubMed  Google Scholar 

  6. Philip P, Stoohs R, Guilleminault C (1994) Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome. Sleep 17:242–247

    CAS  PubMed  Google Scholar 

  7. Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J et al (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370:139–149

    Article  CAS  PubMed  Google Scholar 

  8. McArdle N, Douglas NJ (2001) Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome: a randomized controlled trial. Am J Respir Crit Care Med 164:1459–1463

    Article  CAS  PubMed  Google Scholar 

  9. Narkiewicz K, Somers VK (1999) Obstructive sleep apnea as a cause of neurogenic hypertension. Curr Hypertens Rep 1:268–273

    Article  CAS  PubMed  Google Scholar 

  10. Martinez D, Klein C, Rahmeier L, da Silva RP, Fiori CZ et al (2012) Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors. Sleep Breath 16:695–701

    Article  PubMed  Google Scholar 

  11. Palomäki H, Partinen M, Juvela S, Kaste M (1989) Snoring as a risk factor for sleep-related brain infarction. Stroke 20:1311–1315

    Article  PubMed  Google Scholar 

  12. Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N et al (1985) Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 131:835–839

    CAS  PubMed  Google Scholar 

  13. Lévy P, Bonsignore MR, Eckel J (2009) Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J 34:243–260

    Article  PubMed  Google Scholar 

  14. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682

    Article  PubMed  Google Scholar 

  15. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122:352–360

    Article  PubMed  PubMed Central  Google Scholar 

  16. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev CD001106

  17. Somiah M, Taxin Z, Keating J, Mooney AM, Norman RG et al (2012) Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med 8:489–500

    PubMed  PubMed Central  Google Scholar 

  18. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15:343–356

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD et al (2015) Obstructive sleep apnoea syndrome. Nat Rev Dis Prim 1:15015

    Article  PubMed  Google Scholar 

  20. Kent DT, Lee JJ, Strollo PJ, Soose RJ (2016) Upper airway stimulation for OSA: early adherence and outcome results of one center. Otolaryngol Head Neck Surg

  21. Soose RJ, Woodson BT, Gillespie MB, Maurer JT, de Vries N et al (2016) Upper airway stimulation for obstructive sleep apnea: self-reported outcomes at 24 months. J Clin Sleep Med 12:43–48

    Article  PubMed  PubMed Central  Google Scholar 

  22. Strollo PJ, Gillespie MB, Soose RJ, Maurer JT, de Vries N et al (2015) Upper airway stimulation for obstructive sleep apnea: durability of the treatment effect at 18 months. Sleep 38:1593–1598

    Article  PubMed  PubMed Central  Google Scholar 

  23. Heiser C, Knopf A, Bas M, Gahleitner C, Hofauer B (2016) Selective upper-airway stimulation for obstructive sleep apnea—a single center clinical experience. Eur Arch Otorhinolaryngol

  24. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236

    Article  PubMed  Google Scholar 

  25. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  26. Heiser C, Thaler E, Boon M, Soose RJ, Woodson BT (2016) Updates of operative techniques for upper airway stimulation. Laryngoscope

  27. Heiser C, Hofauer B, Lozier L, Woodson BT, Stark T (2016) Nerve monitoring guided selective hypoglossal nerve stimulation in obstructive sleep apnea. Laryngoscope

  28. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619

    PubMed  PubMed Central  Google Scholar 

  29. Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177

    Article  CAS  PubMed  Google Scholar 

  30. Woodson BT, Soose RJ, Gillespie MB, Strohl KP, Maurer JT et al (2016) Three-year outcomes of cranial nerve stimulation for obstructive sleep apnea: the STAR trial. Otolaryngol Head Neck Surg 154:181–188

    Article  PubMed  Google Scholar 

  31. Woodson BT, Gillespie MB, Soose RJ, Maurer JT, de Vries N et al (2014) Randomized controlled withdrawal study of upper airway stimulation on OSA: short- and long-term effect. Otolaryngol Head Neck Surg 151:880–887

    Article  PubMed  Google Scholar 

  32. Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA et al (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122:1626–1633

    Article  PubMed  Google Scholar 

  33. Verma A, Radtke RA, Van Landingham KE, King JH, Husain AM (2001) Slow wave sleep rebound and REM rebound following the first night of treatment with CPAP for sleep apnea: correlation with subjective improvement in sleep quality. Sleep Med 2:215–223

    Article  CAS  PubMed  Google Scholar 

  34. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A (2004) The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Arch Intern Med 164:406–418

    Article  PubMed  Google Scholar 

  35. Sagaspe P, Taillard J, Chaumet G, Moore N, Bioulac B, Philip P (2007) Aging and nocturnal driving: better with coffee or a nap? A randomized study. Sleep 30:1808–1813

    Article  PubMed  PubMed Central  Google Scholar 

  36. Koo BB, Wiggins R, Molina C (2012) REM rebound and CPAP compliance. Sleep Med 13:864–868

    Article  PubMed  Google Scholar 

  37. Aldrich M, Eiser A, Lee M, Shipley JE (1989) Effects of continuous positive airway pressure on phasic events of REM sleep in patients with obstructive sleep apnea. Sleep 12:413–419

    Article  CAS  PubMed  Google Scholar 

  38. Grimaldi D, Beccuti G, Touma C, Van Cauter E, Mokhlesi B (2014) Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications. Diabetes Care 37:355–363

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mokhlesi B, Finn LA, Hagen EW, Young T, Hla KM et al (2014) Obstructive sleep apnea during REM sleep and hypertension. Results of the Wisconsin sleep cohort. Am J Respir Crit Care Med 190:1158–1167

    Article  PubMed  PubMed Central  Google Scholar 

  40. Fietze I, Quispe-Bravo S, Hänsch T, Röttig J, Baumann G, Witt C (1997) Arousals and sleep stages in patients with obstructive sleep apnoea syndrome: changes under nCPAP treatment. J Sleep res 6:128–133

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Benedikt Hofauer.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

Benedikt Hofauer, Markus Wirth, and Clemens Heiser received research support from Inspire Medical Systems. The article submitted is related to this relationship. Pierre Philip has a relationship with UCB, Sanofi, Takeda, Bastide, and Vital-Aire as a consultant. The article submitted is not related to this relationship. Andreas Knopf received research support from Optima Pharmazeutische GmbH. The article submitted is not related to this relationship. The trial was registered as NCT02293746 (Inspire Upper Airway Stimulation System German Post-Market Study) on clinicaltrial.gov as a sub-investigation of the German Post-Market Study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hofauer, B., Philip, P., Wirth, M. et al. Effects of upper-airway stimulation on sleep architecture in patients with obstructive sleep apnea. Sleep Breath 21, 901–908 (2017). https://doi.org/10.1007/s11325-017-1519-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1519-0

Keywords

Navigation