Lane Fox Unit, Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
Curr Opin Pulm Med. 2022 Nov 1;28(6):529-536. doi: 10.1097/MCP.0000000000000910. Epub 2022 Aug 22.
Obstructive sleep apnoea (OSA) is a highly prevalent condition affecting about 1 billion people worldwide. The first line therapy for most patients with OSA is continuous positive airway pressure (CPAP) therapy. However, there are significant limitations with long-term adherence to CPAP therapy, which may be as low as 30-60%.
Electrical stimulation of the hypoglossal nerve has been studied in recent years. It achieves upper airway patency by causing a contraction of the genioglossus muscle, the strongest dilator of the upper airway, and by maintaining its neuromuscular tone in the asleep patient with OSA. Electrical stimulation can be delivered invasively, hypoglossal nerve stimulation (HNS), and noninvasively, transcutaneous electrical stimulation in OSA (TESLA). However, randomised controlled trials, the STAR and the TESLA trial, have provided promising results on efficacy and safety of the methods.
Patient and public involvement underlines the interest in TESLA and HNS and highlights the need to provide non-CPAP therapeutic options to those who may find it difficult to cope with first line therapies. The relatively low costs and the favourable safety profile of the TESLA approach provide the chance to offer this treatment to patients with OSA following further development of the evidence.
阻塞性睡眠呼吸暂停（OSA）是一种在全球范围内影响约 10 亿人的高发疾病。大多数 OSA 患者的一线治疗方法是持续气道正压通气（CPAP）治疗。然而，CPAP 治疗的长期依从性存在显著限制，其依从率可能低至 30%-60%。
近年来，对舌下神经电刺激进行了研究。它通过引起颏舌肌的收缩来实现上气道通畅，颏舌肌是上气道最强的扩张肌，并在上气道阻力患者睡眠时保持其神经肌肉张力。电刺激可通过侵入性舌下神经刺激（HNS）和非侵入性经皮电刺激 OSA（TESLA）来实现。然而，随机对照试验（STAR 和 TESLA 试验）提供了关于这些方法的疗效和安全性的有希望的结果。
患者和公众的参与强调了对 TESLA 和 HNS 的兴趣，并突出表明需要为那些可能难以应对一线治疗的患者提供非 CPAP 治疗选择。TESLA 方法的相对低成本和有利的安全性特征为进一步开发证据后为 OSA 患者提供这种治疗提供了机会。
