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Sleep and Breathing

, Volume 23, Issue 1, pp 153–160 | Cite as

Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study

  • Allison K. Ikeda
  • Qiao Li
  • Arshed A. Quyuumi
  • Raj C. DedhiaEmail author
Sleep Breathing Physiology and Disorders • Original Article

Abstract

Purpose

Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography.

Methods

Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed.

Results

Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5, p = 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (R2 = <0.12). Across all subjects, poor linear correlation was present between HGNS and PAT signal attenuation (R2 = 0.028) in both adjusted and unadjusted analyses.

Conclusions

Using PAT-integrated polysomnography, PAT output does not appear to be affected by HGNS stimulation at clinical thresholds. These findings support the absence of autonomic system alterations by twelfth nerve stimulation and support the clinical use of PAT-based devices for post-HGNS monitoring. Larger studies examining hard cardiovascular endpoints with HGNS are needed.

Keywords

Hypoglossal nerve stimulation Peripheral arterial tonometry Obstructive sleep apnea Sympathetic activity Polysomnography 

Notes

Acknowledgements

Everett G. Seay, RPSGT, assisted with adjudication of events and study coordination.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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 (place name of institute/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.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Allison K. Ikeda
    • 1
  • Qiao Li
    • 2
  • Arshed A. Quyuumi
    • 3
  • Raj C. Dedhia
    • 4
    • 5
    Email author
  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Department of Biomedical InformaticsEmory UniversityAtlantaUSA
  3. 3.Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaUSA
  4. 4.Department of OtolaryngologyEmory University School of MedicineAtlantaUSA
  5. 5.Emory Sleep Center, Emory HealthcareAtlantaUSA

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