Skip to main content
Erschienen in: Sleep and Breathing 4/2017

31.05.2017 | Sleep Breathing Physiology and Disorders • Original Article

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

verfasst von: Benedikt Hofauer, Pierre Philip, Markus Wirth, Andreas Knopf, Clemens Heiser

Erschienen in: Sleep and Breathing | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Pengo MF, Steier J (2015) Emerging technology: electrical stimulation in obstructive sleep apnoea. J Thorac Dis 7:1286–1297PubMedPubMedCentral Pengo MF, Steier J (2015) Emerging technology: electrical stimulation in obstructive sleep apnoea. J Thorac Dis 7:1286–1297PubMedPubMedCentral
2.
Zurück zum Zitat 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 328:1230–1235CrossRefPubMed 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 328:1230–1235CrossRefPubMed
3.
Zurück zum Zitat Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat 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 69:390–392CrossRefPubMed 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 69:390–392CrossRefPubMed
6.
Zurück zum Zitat Philip P, Stoohs R, Guilleminault C (1994) Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome. Sleep 17:242–247PubMed Philip P, Stoohs R, Guilleminault C (1994) Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome. Sleep 17:242–247PubMed
7.
Zurück zum Zitat 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 370:139–149CrossRefPubMed 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 370:139–149CrossRefPubMed
8.
Zurück zum Zitat 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 164:1459–1463CrossRefPubMed 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 164:1459–1463CrossRefPubMed
9.
Zurück zum Zitat Narkiewicz K, Somers VK (1999) Obstructive sleep apnea as a cause of neurogenic hypertension. Curr Hypertens Rep 1:268–273CrossRefPubMed Narkiewicz K, Somers VK (1999) Obstructive sleep apnea as a cause of neurogenic hypertension. Curr Hypertens Rep 1:268–273CrossRefPubMed
10.
Zurück zum Zitat 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 16:695–701CrossRefPubMed 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 16:695–701CrossRefPubMed
11.
Zurück zum Zitat Palomäki H, Partinen M, Juvela S, Kaste M (1989) Snoring as a risk factor for sleep-related brain infarction. Stroke 20:1311–1315CrossRefPubMed Palomäki H, Partinen M, Juvela S, Kaste M (1989) Snoring as a risk factor for sleep-related brain infarction. Stroke 20:1311–1315CrossRefPubMed
12.
Zurück zum Zitat 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 131:835–839PubMed 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 131:835–839PubMed
13.
Zurück zum Zitat Lévy P, Bonsignore MR, Eckel J (2009) Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J 34:243–260CrossRefPubMed Lévy P, Bonsignore MR, Eckel J (2009) Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J 34:243–260CrossRefPubMed
14.
Zurück zum Zitat 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 165:677–682CrossRefPubMed 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 165:677–682CrossRefPubMed
15.
Zurück zum Zitat 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 122:352–360CrossRefPubMedPubMedCentral 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 122:352–360CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 8:489–500PubMedPubMedCentral 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 8:489–500PubMedPubMedCentral
18.
Zurück zum Zitat 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 15:343–356CrossRefPubMedPubMedCentral 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 15:343–356CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD et al (2015) Obstructive sleep apnoea syndrome. Nat Rev Dis Prim 1:15015CrossRefPubMed Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD et al (2015) Obstructive sleep apnoea syndrome. Nat Rev Dis Prim 1:15015CrossRefPubMed
20.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 12:43–48CrossRefPubMedPubMedCentral 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 12:43–48CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat 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 38:1593–1598CrossRefPubMedPubMedCentral 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 38:1593–1598CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat 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 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.
Zurück zum Zitat Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236CrossRefPubMed Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236CrossRefPubMed
25.
Zurück zum Zitat Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMed Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMed
26.
Zurück zum Zitat Heiser C, Thaler E, Boon M, Soose RJ, Woodson BT (2016) Updates of operative techniques for upper airway stimulation. Laryngoscope Heiser C, Thaler E, Boon M, Soose RJ, Woodson BT (2016) Updates of operative techniques for upper airway stimulation. Laryngoscope
27.
Zurück zum Zitat Heiser C, Hofauer B, Lozier L, Woodson BT, Stark T (2016) Nerve monitoring guided selective hypoglossal nerve stimulation in obstructive sleep apnea. Laryngoscope Heiser C, Hofauer B, Lozier L, Woodson BT, Stark T (2016) Nerve monitoring guided selective hypoglossal nerve stimulation in obstructive sleep apnea. Laryngoscope
28.
Zurück zum Zitat 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 8:597–619PubMedPubMedCentral 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 8:597–619PubMedPubMedCentral
29.
Zurück zum Zitat Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177CrossRefPubMed Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177CrossRefPubMed
30.
Zurück zum Zitat 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 154:181–188CrossRefPubMed 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 154:181–188CrossRefPubMed
31.
Zurück zum Zitat 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 151:880–887CrossRefPubMed 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 151:880–887CrossRefPubMed
32.
Zurück zum Zitat 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 122:1626–1633CrossRefPubMed 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 122:1626–1633CrossRefPubMed
33.
Zurück zum Zitat 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 2:215–223CrossRefPubMed 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 2:215–223CrossRefPubMed
34.
Zurück zum Zitat 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 164:406–418CrossRefPubMed 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 164:406–418CrossRefPubMed
35.
Zurück zum Zitat 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 30:1808–1813CrossRefPubMedPubMedCentral 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 30:1808–1813CrossRefPubMedPubMedCentral
36.
37.
Zurück zum Zitat 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 12:413–419CrossRefPubMed 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 12:413–419CrossRefPubMed
38.
Zurück zum Zitat 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 37:355–363CrossRefPubMedPubMedCentral 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 37:355–363CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat 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 190:1158–1167CrossRefPubMedPubMedCentral 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 190:1158–1167CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat 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 6:128–133CrossRefPubMed 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 6:128–133CrossRefPubMed
Metadaten
Titel
Effects of upper-airway stimulation on sleep architecture in patients with obstructive sleep apnea
verfasst von
Benedikt Hofauer
Pierre Philip
Markus Wirth
Andreas Knopf
Clemens Heiser
Publikationsdatum
31.05.2017
Verlag
Springer International Publishing
Erschienen in
Sleep and Breathing / Ausgabe 4/2017
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-017-1519-0

Weitere Artikel der Ausgabe 4/2017

Sleep and Breathing 4/2017 Zur Ausgabe

Sleep Breathing Physiology and Disorders • Original Article

The effect of sleep duration on exhaled nitric oxide levels in U.S. adults

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.