PDF herunterladen
Semin Respir Crit Care Med 2014; 35(05): 621-628
DOI: 10.1055/s-0034-1390074
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

New Therapies for Obstructive Sleep Apnea

David P. White
1   Department of Medicine, Harvard Medical School, Boston, MA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
29. Oktober 2014 (online)

    Lizenzen und Reprints

Abstract

A strong demand for new obstructive sleep apnea (OSA) therapies exists and several are emerging. Hypoglossal nerve stimulation is designed to activate upper airway muscles. The initial study from Inspire (Maple Grove, MN) suggests that the device will work well in a very selective group of OSA patients. However, it is likely to be quite expensive. The Winx device (ApniCure, Redwood City, CA) works by establishing a vacuum in the oral cavity, which pulls the uvula and soft palate forward and stabilizes the tongue position. The current device works in approximately 40% of patients and the early data suggest adherence may be quite good. The Provent device( Theravent, San Jose, CA) has been available for several years and is disposable. It is to be attached to the nares nightly and establishes substantial expiratory resistance. Multiple studies suggest that Provent can successfully treat OSA in about 35 to 50% of the patients. However, acceptance and adherence may be a problem. OSA phenotyping is not a therapy, but a way to determine exactly what causes airway collapse in each patient, which can vary substantially. This may allow for individualization of apnea therapy. New methods to prevent supine sleep and surgically implantable devices to treat OSA are also evolving.

Keywords

sleep apnea - hypoglossal nerve - Winx - Provent - phenotyping
 

  • References

  • 1 White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 2005; 172 (11) 1363-1370
    CrossrefPubMedGoogle Scholar
  • 2 Kezirian EJ, Boudewyns A, Eisele DW , et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Med Rev 2010; 14 (5) 299-305
    CrossrefPubMedGoogle Scholar
  • 3 Eastwood PR, Barnes M, Walsh JH , et al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 2011; 34 (11) 1479-1486
    PubMedGoogle Scholar
  • 4 Kezirian EJ, Goding Jr GS, Malhotra A , et al. Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes. J Sleep Res 2014; 23 (1) 77-83
    CrossrefPubMedGoogle Scholar
  • 5 Van de Heyning PH, Badr MS, Baskin JZ , et al. Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 2012; 122 (7) 1626-1633
    CrossrefPubMedGoogle Scholar
  • 6 Strollo Jr PJ, Soose RJ, Maurer JT , et al; STAR Trial Group. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 2014; 370 (2) 139-149
    CrossrefPubMedGoogle Scholar
  • 7 Colrain IM, Black J, Siegel LC , et al. A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Sleep Med 2013; 14 (9) 830-837
    CrossrefPubMedGoogle Scholar
  • 8 Braga CW, Chen Q, Burschtin OE, Rapoport DM, Ayappa I. Changes in lung volume and upper airway using MRI during application of nasal expiratory positive airway pressure in patients with sleep-disordered breathing. J Appl Physiol (1985) 2011; 111 (5) 1400-1409
    CrossrefPubMedGoogle Scholar
  • 9 Heinzer RC, Stanchina ML, Malhotra A , et al. Lung volume and continuous positive airway pressure requirements in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172 (1) 114-117
    CrossrefPubMedGoogle Scholar
  • 10 Rosenthal L, Massie CA, Dolan DC, Loomas B, Kram J, Hart RW. A multicenter, prospective study of a novel nasal EPAP device in the treatment of obstructive sleep apnea: efficacy and 30-day adherence. J Clin Sleep Med 2009; 5 (6) 532-537
    PubMedGoogle Scholar
  • 11 Berry RB, Kryger MH, Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep 2011; 34 (4) 479-485
    PubMedGoogle Scholar
  • 12 Kryger MH, Berry RB, Massie CA. Long-term use of a nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). J Clin Sleep Med 2011; 7 (5) 449-53B
    PubMedGoogle Scholar
  • 13 Rossi VA, Winter B, Rahman NM , et al. The effects of Provent on moderate to severe obstructive sleep apnoea during continuous positive airway pressure therapy withdrawal: a randomised controlled trial. Thorax 2013; 68 (9) 854-859
    CrossrefPubMedGoogle Scholar
  • 14 Patel AV, Hwang D, Masdeu MJ, Chen GM, Rapoport DM, Ayappa I. Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. J Clin Sleep Med 2011; 7 (1) 13-22
    PubMedGoogle Scholar
  • 15 Wellman A, Eckert DJ, Jordan AS , et al. A method for measuring and modeling the physiological traits causing obstructive sleep apnea. J Appl Physiol (1985) 2011; 110 (6) 1627-1637
    CrossrefPubMedGoogle Scholar
  • 16 Wellman A, Edwards BA, Sands SA , et al. A simplified method for determining phenotypic traits in patients with obstructive sleep apnea. J Appl Physiol (1985) 2013; 114 (7) 911-922
    CrossrefPubMedGoogle Scholar
  • 17 Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 2013; 188 (8) 996-1004
    CrossrefPubMedGoogle Scholar
  • 18 Schwab RJ, Pasirstein M, Pierson R , et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168 (5) 522-530
    CrossrefPubMedGoogle Scholar
  • 19 Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 2003; 168 (6) 645-658
    CrossrefPubMedGoogle Scholar
  • 20 Berry RB, Gleeson K. Respiratory arousal from sleep: mechanisms and significance. Sleep 1997; 20 (8) 654-675
    PubMedGoogle Scholar
  • 21 Younes M, Ostrowski M, Atkar R, Laprairie J, Siemens A, Hanly P. Mechanisms of breathing instability in patients with obstructive sleep apnea. J Appl Physiol (1985) 2007; 103 (6) 1929-1941
    CrossrefPubMedGoogle Scholar
  • 22 Grace KP, Hughes SW, Horner RL. Identification of a pharmacological target for genioglossus reactivation throughout sleep. Sleep 2014; 37 (1) 41-50
    PubMedGoogle Scholar
  • 23 Eckert DJ, Owens RL, Kehlmann GB , et al. Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond) 2011; 120 (12) 505-514
    CrossrefPubMedGoogle Scholar
  • 24 Heinzer RC, White DP, Jordan AS , et al. Trazodone increases arousal threshold in obstructive sleep apnoea. Eur Respir J 2008; 31 (6) 1308-1312
    CrossrefPubMedGoogle Scholar
  • 25 Wellman A, Malhotra A, Jordan AS, Stevenson KE, Gautam S, White DP. Effect of oxygen in obstructive sleep apnea: role of loop gain. Respir Physiol Neurobiol 2008; 162 (2) 144-151
    CrossrefPubMedGoogle Scholar
  • 26 Edwards BA, Sands SA, Eckert DJ , et al. Acetazolamide improves loop gain but not the other physiological traits causing obstructive sleep apnoea. J Physiol 2012; 590 (Pt 5) 1199-1211
    CrossrefPubMedGoogle Scholar
  • 27 Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG. Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med 2011; 7 (4) 376-383
    PubMedGoogle Scholar
  • 28 van Maanen JP, Meester KA, Dun LN , et al. The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath 2013; 17 (2) 771-779
    CrossrefPubMedGoogle Scholar
  • 29 Hamans E, Boudewyns A, Stuck BA , et al. Adjustable tongue advancement for obstructive sleep apnea: a pilot study. Ann Otol Rhinol Laryngol 2008; 117 (11) 815-823
    PubMedGoogle Scholar
  • 30 Woodson BT, Steward DL, Mickelson S, Huntley T, Goldberg A. Multicenter study of a novel adjustable tongue-advancement device for obstructive sleep apnea. Otolaryngol Head Neck Surg 2010; 143 (4) 585-590
    CrossrefPubMedGoogle Scholar
  • 31 Pavelec V, Hamans E, Stuck BA. A study of the new generation of the advance system tongue implants: three- and six-month effects of tongue to mandible tethering for obstructive sleep apnea. Laryngoscope 2011; 121 (11) 2487-2493
    CrossrefPubMedGoogle Scholar