Schwartz A R, Bennett M L, Smith P L, De Backer W, Hedner J, Boudewyns A, Van de Heyning P, Ejnell H, Hochban W, Knaack L, Podszus T, Penzel T, Peter J H, Goding G S, Erickson D J, Testerman R, Ottenhoff F, Eisele D W
Sleep Disorders Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Cir, Baltimore, MD 21224, USA.
Arch Otolaryngol Head Neck Surg. 2001 Oct;127(10):1216-23. doi: 10.1001/archotol.127.10.1216.
Hypoglossal nerve stimulation has been demonstrated to relieve upper airway obstruction acutely, but its effect on obstructive sleep apnea is not known.
To determine the response in obstructive sleep apnea to electrical stimulation of the hypoglossal nerve.
Eight patients with obstructive sleep apnea were implanted with a device that stimulated the hypoglossal nerve unilaterally during inspiration. Sleep and breathing patterns were examined at baseline before implantation and after implantation at 1, 3, and 6 months and last follow-up.
Unilateral hypoglossal nerve stimulation decreased the severity of obstructive sleep apnea throughout the entire study period. Specifically, stimulation significantly reduced the mean apnea-hypopnea indices in non-rapid eye movement (mean +/- SD episodes per hour, 52.0 +/- 20.4 for baseline nights and 22.6 +/- 12.1 for stimulation nights; P<.001) and rapid eye movement (48.2 +/- 30.5 and 16.6 +/- 17.1, respectively; P<.001) sleep and reduced the severity of oxyhemoglobin desaturations. With improvement in sleep apnea, a trend toward deeper stages of non-rapid eye movement sleep was observed. Moreover, all patients tolerated long-term stimulation at night and did not experience any adverse effects from stimulation. Even after completing the study protocol, the 3 patients who remained free from stimulator malfunction continued to use this device as primary treatment.
The findings demonstrate the feasibility and therapeutic potential for hypoglossal nerve stimulation in obstructive sleep apnea.
已证实舌下神经刺激可急性缓解上气道阻塞，但其对阻塞性睡眠呼吸暂停的影响尚不清楚。
确定阻塞性睡眠呼吸暂停对舌下神经电刺激的反应。
8例阻塞性睡眠呼吸暂停患者植入一种在吸气时单侧刺激舌下神经的装置。在植入前的基线以及植入后1、3、6个月和末次随访时检查睡眠和呼吸模式。
在整个研究期间，单侧舌下神经刺激降低了阻塞性睡眠呼吸暂停的严重程度。具体而言，刺激显著降低了非快速眼动睡眠（每小时平均±标准差发作次数，基线夜为52.0±20.4，刺激夜为22.6±12.1；P<0.001）和快速眼动睡眠（分别为48.2±30.5和16.6±17.1；P<0.001）中的平均呼吸暂停低通气指数，并减轻了氧合血红蛋白饱和度降低的严重程度。随着睡眠呼吸暂停的改善，观察到非快速眼动睡眠向更深阶段发展的趋势。此外，所有患者均耐受夜间长期刺激，且未出现刺激的任何不良反应。即使在完成研究方案后，3例未出现刺激器故障的患者仍继续使用该装置作为主要治疗方法。
这些发现证明了舌下神经刺激治疗阻塞性睡眠呼吸暂停的可行性和治疗潜力。
