Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis

Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutan...
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Autor*in:	Ratneswaran, Deeban [verfasserIn] Guni, Ahmad [verfasserIn] Pengo, Martino F [verfasserIn] Al-Sherif, Miral [verfasserIn] He, Baiting [verfasserIn] Cheng, Michael CF [verfasserIn] Steier, Joerg [verfasserIn] Schwarz, Esther I [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	Obstructive sleep apnea Hypoglossal nerve stimulation Transcutaneous electrical stimulation Upper airway collapse

Übergeordnetes Werk:	Enthalten in: Sleep and breathing - Berlin : Springer, 1996, 25(2020), 1 vom: 09. Mai, Seite 207-218
Übergeordnetes Werk:	volume:25 ; year:2020 ; number:1 ; day:09 ; month:05 ; pages:207-218

Links:	Volltext

DOI / URN:	10.1007/s11325-020-02069-2

Katalog-ID:	SPR043593798

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245	1	0	\|a Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
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520			\|a Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
650		4	\|a Obstructive sleep apnea \|7 (dpeaa)DE-He213
650		4	\|a Hypoglossal nerve stimulation \|7 (dpeaa)DE-He213
650		4	\|a Transcutaneous electrical stimulation \|7 (dpeaa)DE-He213
650		4	\|a Upper airway collapse \|7 (dpeaa)DE-He213
700	1		\|a Guni, Ahmad \|e verfasserin \|4 aut
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700	1		\|a Cheng, Michael CF \|e verfasserin \|4 aut
700	1		\|a Steier, Joerg \|e verfasserin \|4 aut
700	1		\|a Schwarz, Esther I \|e verfasserin \|4 aut
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publishDate	2020
allfields	10.1007/s11325-020-02069-2 doi (DE-627)SPR043593798 (DE-599)SPRs11325-020-02069-2-e (SPR)s11325-020-02069-2-e DE-627 ger DE-627 rakwb eng 610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Ratneswaran, Deeban verfasserin aut Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA. Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213 Guni, Ahmad verfasserin aut Pengo, Martino F verfasserin aut Al-Sherif, Miral verfasserin aut He, Baiting verfasserin aut Cheng, Michael CF verfasserin aut Steier, Joerg verfasserin aut Schwarz, Esther I verfasserin aut Enthalten in Sleep and breathing Berlin : Springer, 1996 25(2020), 1 vom: 09. Mai, Seite 207-218 (DE-627)342891839 (DE-600)2072363-5 1522-1709 nnns volume:25 year:2020 number:1 day:09 month:05 pages:207-218 https://dx.doi.org/10.1007/s11325-020-02069-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.84 ASE 44.90 ASE 77.47 ASE AR 25 2020 1 09 05 207-218
spelling	10.1007/s11325-020-02069-2 doi (DE-627)SPR043593798 (DE-599)SPRs11325-020-02069-2-e (SPR)s11325-020-02069-2-e DE-627 ger DE-627 rakwb eng 610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Ratneswaran, Deeban verfasserin aut Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA. Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213 Guni, Ahmad verfasserin aut Pengo, Martino F verfasserin aut Al-Sherif, Miral verfasserin aut He, Baiting verfasserin aut Cheng, Michael CF verfasserin aut Steier, Joerg verfasserin aut Schwarz, Esther I verfasserin aut Enthalten in Sleep and breathing Berlin : Springer, 1996 25(2020), 1 vom: 09. Mai, Seite 207-218 (DE-627)342891839 (DE-600)2072363-5 1522-1709 nnns volume:25 year:2020 number:1 day:09 month:05 pages:207-218 https://dx.doi.org/10.1007/s11325-020-02069-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.84 ASE 44.90 ASE 77.47 ASE AR 25 2020 1 09 05 207-218
allfields_unstemmed	10.1007/s11325-020-02069-2 doi (DE-627)SPR043593798 (DE-599)SPRs11325-020-02069-2-e (SPR)s11325-020-02069-2-e DE-627 ger DE-627 rakwb eng 610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Ratneswaran, Deeban verfasserin aut Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA. Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213 Guni, Ahmad verfasserin aut Pengo, Martino F verfasserin aut Al-Sherif, Miral verfasserin aut He, Baiting verfasserin aut Cheng, Michael CF verfasserin aut Steier, Joerg verfasserin aut Schwarz, Esther I verfasserin aut Enthalten in Sleep and breathing Berlin : Springer, 1996 25(2020), 1 vom: 09. Mai, Seite 207-218 (DE-627)342891839 (DE-600)2072363-5 1522-1709 nnns volume:25 year:2020 number:1 day:09 month:05 pages:207-218 https://dx.doi.org/10.1007/s11325-020-02069-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.84 ASE 44.90 ASE 77.47 ASE AR 25 2020 1 09 05 207-218
allfieldsGer	10.1007/s11325-020-02069-2 doi (DE-627)SPR043593798 (DE-599)SPRs11325-020-02069-2-e (SPR)s11325-020-02069-2-e DE-627 ger DE-627 rakwb eng 610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Ratneswaran, Deeban verfasserin aut Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA. Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213 Guni, Ahmad verfasserin aut Pengo, Martino F verfasserin aut Al-Sherif, Miral verfasserin aut He, Baiting verfasserin aut Cheng, Michael CF verfasserin aut Steier, Joerg verfasserin aut Schwarz, Esther I verfasserin aut Enthalten in Sleep and breathing Berlin : Springer, 1996 25(2020), 1 vom: 09. Mai, Seite 207-218 (DE-627)342891839 (DE-600)2072363-5 1522-1709 nnns volume:25 year:2020 number:1 day:09 month:05 pages:207-218 https://dx.doi.org/10.1007/s11325-020-02069-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.84 ASE 44.90 ASE 77.47 ASE AR 25 2020 1 09 05 207-218
allfieldsSound	10.1007/s11325-020-02069-2 doi (DE-627)SPR043593798 (DE-599)SPRs11325-020-02069-2-e (SPR)s11325-020-02069-2-e DE-627 ger DE-627 rakwb eng 610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Ratneswaran, Deeban verfasserin aut Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA. Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213 Guni, Ahmad verfasserin aut Pengo, Martino F verfasserin aut Al-Sherif, Miral verfasserin aut He, Baiting verfasserin aut Cheng, Michael CF verfasserin aut Steier, Joerg verfasserin aut Schwarz, Esther I verfasserin aut Enthalten in Sleep and breathing Berlin : Springer, 1996 25(2020), 1 vom: 09. Mai, Seite 207-218 (DE-627)342891839 (DE-600)2072363-5 1522-1709 nnns volume:25 year:2020 number:1 day:09 month:05 pages:207-218 https://dx.doi.org/10.1007/s11325-020-02069-2 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.84 ASE 44.90 ASE 77.47 ASE AR 25 2020 1 09 05 207-218
language	English
source	Enthalten in Sleep and breathing 25(2020), 1 vom: 09. Mai, Seite 207-218 volume:25 year:2020 number:1 day:09 month:05 pages:207-218
sourceStr	Enthalten in Sleep and breathing 25(2020), 1 vom: 09. Mai, Seite 207-218 volume:25 year:2020 number:1 day:09 month:05 pages:207-218
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Obstructive sleep apnea Hypoglossal nerve stimulation Transcutaneous electrical stimulation Upper airway collapse
dewey-raw	610
isfreeaccess_bool	false
container_title	Sleep and breathing
authorswithroles_txt_mv	Ratneswaran, Deeban @@aut@@ Guni, Ahmad @@aut@@ Pengo, Martino F @@aut@@ Al-Sherif, Miral @@aut@@ He, Baiting @@aut@@ Cheng, Michael CF @@aut@@ Steier, Joerg @@aut@@ Schwarz, Esther I @@aut@@
publishDateDaySort_date	2020-05-09T00:00:00Z
hierarchy_top_id	342891839
dewey-sort	3610
id	SPR043593798
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">SPR043593798</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230519155658.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">210324s2020 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1007/s11325-020-02069-2</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)SPR043593798</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)SPRs11325-020-02069-2-e</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(SPR)s11325-020-02069-2-e</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">ASE</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.84</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.90</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">77.47</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Ratneswaran, Deeban</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2020</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. 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author	Ratneswaran, Deeban
spellingShingle	Ratneswaran, Deeban ddc 610 bkl 44.84 bkl 44.90 bkl 77.47 misc Obstructive sleep apnea misc Hypoglossal nerve stimulation misc Transcutaneous electrical stimulation misc Upper airway collapse Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
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topic_title	610 ASE 44.84 bkl 44.90 bkl 77.47 bkl Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis Obstructive sleep apnea (dpeaa)DE-He213 Hypoglossal nerve stimulation (dpeaa)DE-He213 Transcutaneous electrical stimulation (dpeaa)DE-He213 Upper airway collapse (dpeaa)DE-He213
topic	ddc 610 bkl 44.84 bkl 44.90 bkl 77.47 misc Obstructive sleep apnea misc Hypoglossal nerve stimulation misc Transcutaneous electrical stimulation misc Upper airway collapse
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title	Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
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title_full	Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
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author_browse	Ratneswaran, Deeban Guni, Ahmad Pengo, Martino F Al-Sherif, Miral He, Baiting Cheng, Michael CF Steier, Joerg Schwarz, Esther I
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title_sort	electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
title_auth	Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
abstract	Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
abstractGer	Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
abstract_unstemmed	Purpose Electrical stimulation of the upper airway dilator muscles is an emerging treatment for obstructive sleep apnea (OSA). Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. While HNS represents an invasive treatment for selected patients with moderate to severe OSA, TES should be further investigated as potential non-invasive approach for OSA.
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container_issue	1
title_short	Electrical stimulation as a therapeutic approach in obstructive sleep apnea — a meta-analysis
url	https://dx.doi.org/10.1007/s11325-020-02069-2
remote_bool	true
author2	Guni, Ahmad Pengo, Martino F Al-Sherif, Miral He, Baiting Cheng, Michael CF Steier, Joerg Schwarz, Esther I
author2Str	Guni, Ahmad Pengo, Martino F Al-Sherif, Miral He, Baiting Cheng, Michael CF Steier, Joerg Schwarz, Esther I
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doi_str	10.1007/s11325-020-02069-2
up_date	2024-07-03T19:39:47.347Z
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Invasive hypoglossal nerve stimulation (HNS) has been accepted as treatment alternative to continuous positive airway pressure (CPAP) for selected patients, while transcutaneous electrical stimulation (TES) of the upper airway is being investigated as non-invasive alternative. Methods A meta-analysis (CRD42017074674) on the effects of both HNS and TES on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) in OSA was conducted including published evidence up to May 2018. Random-effects models were used. Heterogeneity and between-study variance were assessed by $ I^{2} $ and $ τ^{2} $, respectively. Results Of 41 identified clinical trials, 20 interventional trials (n = 895) could be pooled in a meta-analysis (15 HNS [n = 808], 5 TES [n = 87]). Middle-aged (mean ± SD 56.9 ± 5.5 years) and overweight (body mass index 29.1 ± 1.5 kg/$ m^{2} $) patients with severe OSA (AHI 37.5 ± 7.0/h) were followed-up for 6.9 ± 4.0 months (HNS) and 0.2 ± 0.4 months (TES), respectively. The AHI improved by − 24.9 $ h^{−1} $ [95%CI − 28.5, − 21.2] in HNS ($ χ^{2} $ 79%, $ I^{2} $ 82%) and by − 16.5 $ h^{−1} $ [95%CI − 25.1, − 7.8] in TES ($ χ^{2} $ 7%, $ I^{2} $ 43%; both p < 0.001). The ESS was reduced by − 5.0 (95%CI − 5.9, − 4.1) (p < 0.001). Conclusion Both invasive and transcutaneous electrical stimulation reduce OSA severity by a clinically relevant margin. HNS results in a clinically relevant improvement of symptoms. 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