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Somnologie

, Volume 21, Issue 2, pp 140–148 | Cite as

Hypoglossusnervstimulation bei obstruktiver Schlafapnoe

Eine neue Therapieoption bei CPAP-Intoleranz?
  • C. Heiser
  • A. Steffen
  • W. Randerarth
  • T. Penzel
Übersichten
  • 181 Downloads

Zusammenfassung

Der Goldstandard in der Behandlung der obstruktiven Schlafapnoe (OSA) ist die nächtliche kontinuierliche Positivdruckbeatmung, die „continuous positive airway pressure“ (CPAP). Ein gewisser Anteil der Patienten toleriert diese Therapie jedoch nicht und nutzt sie nur unzureichend. Seit einiger Zeit ist nun die nächtliche Stimulation des N. hypoglossus als alternatives Behandlungsverfahren verfügbar. Zurzeit befinden sich zwei Systeme auf dem Markt, die sich sowohl technisch als auch hinsichtlich der vorhandenen Evidenz unterscheiden.

Dieser Beitrag gibt eine Übersicht über den Ablauf, die Funktionsweise und die Datenlage dieser beiden Systeme.

Schlüsselwörter

Oberer Atemweg CPAP-Intoleranz Elektrische Stimulation Biomedizinische Forschung Obere Atemwegstimulation 

Hypoglossal nerve stimulation in obstructive sleep apnea

A new therapy option for CPAP intolerance?

Abstract

The gold standard in the treatment of obstructive sleep apnea is nocturnal continuous positive airway pressure (CPAP). However, a significant percentage of patients do not tolerate CPAP and hence do not adhere to treatment. For the last few years, electrical stimulation of the hypoglossal nerve has been available as an alternative treatment. Currently, two systems are commercially available, which differ with regards to the methods of action and available clinical evidence.

This article provides an overview of treatment paths, functions and available data from clinical studies as well as real-world evidence from registries.

Keywords

Upper airway CPAP Incompliance Electric stimulation Biomedical research Upper airway stimulation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Heiser, A. Steffen und W. Randerarth erhalten von Inspire Medical Systems Vortragshonorare und finanzielle Unterstützung bei Forschungsprojekten. T. Penzel erhielt von Apnex und ImThera Unterstützung bei Forschungsprojekten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Barger LK, Rajaratnam SM, Wang W, O’Brien CS, Sullivan JP, Qadri S, Lockley SW, Czeisler CA, Harvard Work Hours H, Safety G (2015) Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. J Clin Sleep Med 11:233–240PubMedPubMedCentralGoogle Scholar
  2. 2.
    Bartolucci ML, Bortolotti F, Raffaelli E, D’Anto V, Michelotti A, Alessandri Bonetti G (2016) The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis. Sleep Breath. doi: 10.1007/s11325-015-1307-7 PubMedGoogle Scholar
  3. 3.
    Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA (1985) Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 131:835–839PubMedGoogle Scholar
  4. 4.
    Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD (2010) Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 33:1396–1407CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dursunoglu N, Dursunoglu D, Ozkurt S, Kuru O, Gur S, Kiter G, Evyapan F (2007) Effects of CPAP on left ventricular structure and myocardial performance index in male patients with obstructive sleep apnoea. Sleep Med 8:51–59CrossRefPubMedGoogle Scholar
  6. 6.
    Friedman M, Jacobowitz O, Hwang MS, Bergler W, Fietze I, Rombaux P, Mwenge GB, Yalamanchali S, Campana J, Maurer JT (2016) Targeted hypoglossal nerve stimulation for the treatment of obstructive sleep apnea: Six-month results. Laryngoscope. doi: 10.1002/lary.25909 Google Scholar
  7. 7.
    Heiser C, Hofauer B, Lozier L, Woodson BT, Stark T (2016) Nerve monitoring-guided selective hypoglossal nerve stimulation in obstructive sleep apnea patients. Laryngoscope. doi: 10.1002/lary.26026 Google Scholar
  8. 8.
    Heiser C, Knopf A, Murat B, Gahleitner C, Hofauer B (2016) Selective upper-airway stimulation for obstructive sleep apnea – a single center clinical experience. Eur Arch Otorhinolaryngol. doi: 10.1007/s00405-016-4297-6 PubMedGoogle Scholar
  9. 9.
    Heiser C, Maurer JT, Steffen A (2016) Functional outcome of tongue motions with selective hypoglossal nerve stimulation in patients with obstructive sleep apnea. Sleep Breath 20:553–560CrossRefPubMedGoogle Scholar
  10. 10.
    Heiser C, Thaler E, Boon M, Soose RJ, Woodson BT (2016) Updates of operative techniques for upper airway stimulation. Laryngoscope 126(Suppl 7):S12–S16CrossRefPubMedGoogle Scholar
  11. 11.
    Kent DT, Lee JJ, Strollo PJ Jr., Soose RJ (2016) Upper airway stimulation for OSA: early adherence and outcome results of one center. Otolaryngol Head Neck Surg 155:188–193CrossRefPubMedGoogle Scholar
  12. 12.
    Kezirian EJ, Goding GS Jr., Malhotra A, O’Donoghue FJ, Zammit G, Wheatley JR, Catcheside PG, Smith PL, Schwartz AR, Walsh JH, Maddison KJ, Claman DM, Huntley T, Park SY, Campbell MC, Palme CE, Iber C, Eastwood PR, Hillman DR, Barnes M (2014) Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes. J Sleep Res 23:77–83CrossRefPubMedGoogle Scholar
  13. 13.
    Levy P, Bonsignore MR, Eckel J (2009) Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J 34:243–260CrossRefPubMedGoogle Scholar
  14. 14.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053CrossRefPubMedGoogle Scholar
  15. 15.
    Martinez D, Klein C, Rahmeier L, da Silva RP, Fiori CZ, Cassol CM, Goncalves SC, Bos AJ (2012) Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors. Sleep Breath 16:695–701CrossRefPubMedGoogle Scholar
  16. 16.
    McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:1108–1114CrossRefPubMedGoogle Scholar
  17. 17.
    Mwenge GB, Rombaux P, Dury M, Lengele B, Rodenstein D (2013) Targeted hypoglossal neurostimulation for obstructive sleep apnoea: a 1-year pilot study. Eur Respir J 41:360–367CrossRefPubMedGoogle Scholar
  18. 18.
    Ong AA, Murphey AW, Nguyen SA, Soose RJ, Woodson BT, Vanderveken OM, de Vries N, Gillespie MB (2016) Efficacy of upper airway stimulation on collapse patterns observed during drug-induced sedation endoscopy. Otolaryngol Head Neck Surg 154:970–977CrossRefPubMedGoogle Scholar
  19. 19.
    Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    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 165:677–682CrossRefPubMedGoogle Scholar
  21. 21.
    Rodenstein D, Rombaux P, Lengele B, Dury M, Mwenge GB (2013) Residual effect of THN hypoglossal stimulation in obstructive sleep apnea: a disease-modifying therapy. Am J Respir Crit Care Med 187:1276–1278CrossRefPubMedGoogle Scholar
  22. 22.
    Safiruddin F, Vanderveken OM, de Vries N, Maurer JT, Lee K, Ni Q, Strohl KP (2015) Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions. Eur Respir J 45:129–138CrossRefPubMedGoogle Scholar
  23. 23.
    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 15:343–356CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Schwartz AR, Bennett ML, Smith PL, De Backer W, Hedner J, Boudewyns A, Heyning P, Ejnell H, Hochban W, Knaack L, Podszus T, Penzel T, Peter JH, Goding GS, Erickson DJ, Testerman R, Ottenhoff F, Eisele DW (2001) Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 127:1216–1223CrossRefPubMedGoogle Scholar
  25. 25.
    Schwartz AR, Eisele DW, Hari A, Testerman R, Erickson D, Smith PL (1996) Electrical stimulation of the lingual musculature in obstructive sleep apnea. J Appl Physiol 1985(81):643–652Google Scholar
  26. 26.
    Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177CrossRefPubMedGoogle Scholar
  27. 27.
    Steffen A, Frenzel H, Wollenberg B, Konig IR (2015) Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable? Sleep Breath. doi: 10.1007/s11325-015-1277-9 Google Scholar
  28. 28.
    Stradling JR, Davies RJ (2000) Is more NCPAP better? Sleep 23(Suppl 4):S150–S153PubMedGoogle Scholar
  29. 29.
    Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O et al. (2014) Upper-Airway Stimulation for Obstructive Sleep Apnea. New England Journal of Medicine 370(2):139–149Google Scholar
  30. 30.
    Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, Hohenhorst W, Knaack L, Lin HS, Maurer JT, Netzer A, Odland RM, Oliven A, Strohl KP, Vanderveken OM, Verbraecken J, Woodson BT (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122:1626–1633CrossRefPubMedGoogle Scholar
  31. 31.
    Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9:433–438PubMedPubMedCentralGoogle Scholar
  32. 32.
    Verse T, Dreher A, Heiser C, Herzog M, Maurer JT, Pirsig W, Rohde K, Rothmeier N, Sauter A, Steffen A, Wenzel S, Stuck BA (2016) S2e-guideline: „ENT-specific therapy of obstructive sleep apnea in adults“ short version : Sleep Medicine Task Force of the German Society for Otorhinolaryngology, Head and Neck Surgery. HNO 64:310–319CrossRefPubMedGoogle Scholar
  33. 33.
    Woodson BT, Soose RJ, Gillespie MB, Strohl KP, Maurer JTM, de Vries N, Steward DL, Baskin JZ, Badr MS, Lin HS, Padhya TA, Mickelson S, Anderson WM, Vanderveken OM, Strollo PJ Jr., Investigators ST (2016) Three-year outcomes of cranial nerve stimulation for obstructive sleep apnea: the STAR trial. Otolaryngol Head Neck Surg 154:181–188CrossRefPubMedGoogle Scholar
  34. 34.
    Zhu Y, Long H, Jian F, Lin J, Zhu J, Gao M, Lai W (2015) The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. J Dent 43:1394–1402CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin 2016

Authors and Affiliations

  1. 1.Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der IsarTechnische Universität MünchenMünchenDeutschland
  2. 2.Hals-Nasen-OhrenklinikUniversität LübeckLübeckDeutschland
  3. 3.Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und BeatmungsmedizinKrankenhaus BethanienSolingenDeutschland
  4. 4.Interdisziplinäres Schlafmedizinisches ZentrumCharité Universitätsmedizin BerlinBerlinDeutschland

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