Wang Mingfeng, Yin Xiaoming, Liang Yuming, Zhang Cunyun, Zhang Xiaofei, Jiang Xiaochun, Hu Ting
Department of General Practice, Anqing Municipal Hospital, Anqing, Anhui, China.
Anqing Medical College, Anqing, Anhui, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e44103. doi: 10.1097/MD.0000000000044103.
The objective of this study was to compare the efficacy of hypoglossal nerve stimulation (HNS), submental electrical stimulation (SMES), and transcutaneous electrical nerve stimulation (TENS) on key outcomes in obstructive sleep apnea (OSA).
A network meta-analysis was conducted using data from 12 randomized controlled trials involving 677 OSA patients. Trials were identified through a systematic search of PubMed, Embase, and Cochrane Library databases up to June 2024. Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs) for Apnea-Hypopnea Index (AHI), oxygen saturation, Oxygen Desaturation Index, lowest oxygen saturation during sleep (LSAT), and Epworth Sleepiness Scale. Random-effects models were used to synthesize the data and estimate both direct and indirect effects.
SMES exhibited the greatest reduction in AHI (SMD = -1.14, 95% CI [-1.51, -0.78]) and was most effective for improving oxygen saturation (SMD = 0.80, 95% CI [0.48, 1.12]) and ODI (SMD = -0.92, 95% CI [-1.27, -0.57]). TENS significantly improved LSAT (SMD = 0.68, 95% CI [0.30, 1.06]). HNS produced the largest improvement in Epworth Sleepiness Scale (SMD = -1.03, 95% CI [-1.53, -0.53]).
SMES, TENS, and HNS are effective treatments for OSA. SMES is physiologically superior for reducing AHI and improving oxygenation, owing to its ability to stimulate multiple upper-airway muscles and induce long-term neuromuscular adaptation. TENS improves LSAT by enhancing respiratory muscle performance, and HNS effectively reduces daytime sleepiness. These therapies offer modality-specific benefits that may support personalized OSA management.
本研究的目的是比较舌下神经刺激（HNS）、颏下电刺激（SMES）和经皮电神经刺激（TENS）对阻塞性睡眠呼吸暂停（OSA）关键结局的疗效。
使用来自12项随机对照试验的数据进行网络荟萃分析，这些试验涉及677例OSA患者。通过系统检索截至2024年6月的PubMed、Embase和Cochrane图书馆数据库来识别试验。使用标准化均数差（SMD）及95%置信区间（CI）计算呼吸暂停低通气指数（AHI）、血氧饱和度、氧去饱和指数、睡眠期间最低血氧饱和度（LSAT）和爱泼华嗜睡量表的效应量。采用随机效应模型合成数据并估计直接和间接效应。
SMES使AHI降低幅度最大（SMD = -1.14，95% CI [-1.51, -0.78]），并且在改善血氧饱和度（SMD = 0.80，95% CI [0.48, 1.12]）和氧去饱和指数（SMD = -0.92，95% CI [-!27, -0.57]）方面最有效。TENS显著改善了LSAT（SMD = 0.68，95% CI [0.30, 1.06]）。HNS在爱泼华嗜睡量表上的改善最为显著（SMD = -1.03，95% CI [-1.53, -0.53]）。
SMES、TENS和HNS都是治疗OSA的有效方法。由于SMES能够刺激多个上气道肌肉并诱导长期神经肌肉适应，因此在降低AHI和改善氧合方面具有生理优势。TENS通过增强呼吸肌性能来改善LSAT，而HNS能有效减轻日间嗜睡。这些疗法提供了特定方式的益处，可能有助于OSA的个性化管理。
