Upper Airway Stimulation in Patients with Obstructive Sleep Apnea: Long-Term Surgical Success, Respiratory Outcomes, and Patient Experience

Abstract Introduction Upper airway stimulation (UAS) with electric activation of the hypo-glossal nerve has emerged as a promising treatment for patients with moderate-to-severe obstructive sleep apnea. Objective To retrospectively analyze objective and subjective outcome measures after long-term follow-up in obstructive sleep apnea patients receiving upper airway stimulation. Methods An observational retrospective single-center cohort study including a consecutive series of patients diagnosed with obstructive sleep apnea receiving upper airway stimulation. Results Twenty-five patients were included. The total median apnea-hypopnea index (AHI) significantly decreased from 37.4 to 8.7 events per hour at the 12-month follow-up (p < 0.001). The surgical success rate was 96%. Adverse events were reported by 28% of the patients. Conclusion Upper airway stimulation is an effective and safe treatment for obstructive sleep apnea in patients with continuous positive airway pressure (CPAP) failure or intolerance. However, it is possible that the existing in and exclusion criteria for UAS therapy in the Netherlands have positively influenced our results.

Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review / 대한배뇨장애요실금학회지

Neuromodulation was introduced for patients with poor outcomes from the existing traditional treatment approaches. It is well-established as an alternative, novel treatment option for voiding dysfunction. The current system of neuromodulation uses an open-loop system that only delivers continuous stimulation without considering the patient’s state changes. Though the conventional open-loop system has shown positive clinical results, it can cause problems such as decreased efficacy over time due to neural habituation, higher risk of tissue damage, and lower battery life. Therefore, there is a need for a closed-loop system to overcome the disadvantages of existing systems. The closed-loop neuromodulation includes a system to monitor and stimulate micturition reflex pathways from the lower urinary tract, as well as the central nervous system. In this paper, we reviewed the current technological status to measure biomarker for closed-loop neuromodulation systems for voiding dysfunction.

An Implantable Device for Treatment of Obstructive Sleep Apnea: Hypoglossal Nerve Stimulation Therapy / 대한이비인후과학회지

Among current treatment options for obstructive sleep apnea (OSA) including surgeries and oral appliances, positive airway pressure (PAP) is accepted as a standard modality, particularly for moderate to severe OSA patients. Because long-term compliance for PAP is less than 50%, however, strong demands for a novel therapy have existed. Based on the findings that electromyographic activities of pharyngeal dilator muscles are significantly decreased in OSA patients during sleep, researches on hypoglossal nerve stimulation (HGNS) have been conducted. Therapeutic effects of HGNS on OSA have been proven through a series of clinical trials, and the American Food and Drug Administration recently approved its application on moderate to severe OSA patients who failed or are intolerant to PAP treatment. Given recent advances in HGNS therapy, it would be timely to review the history of HGNS and discuss its clinical implications.