Changes of respiratory cycle sensing affects therapy outcome in Upper Airway Stimulation in obstructive sleep apnea

Upper-Airway-Stimulation (UAS) is regarded as a well-established therapy option for obstructive sleep apnea (OSA) in PAP failure. Previous studies showed that treatment is affected by electrode configuration and tongue motion patterns. Up to now, there is no data regarding the influence of respiratory sensing and whether respiratory sensing contributes to successful UAS.

Patients implanted for at least 6 months, beeing therapy responders and showing good respiratory sensing were recruited for the study. To reduce interrater and night-to-night variability, doubled home sleep tests were conducted (Watch-PAT®, Itamar, Israel). After initial measurements (M1), the sensing signal was inverted (Inverse OFF to ON; M2) without changing other parameters. Two weeks later, the signal was converted back again and the sensitiveness of the breathing cycle detection was turned to a very low state (M3). Another two weeks later, all parameters were changed back to initial values for 2 weeks (M4).

At M2 and M3, there the apnoea hypopnoea index and oxygen desaturation index doubled for the entire night and for the time in supine position. Daytime sleepiness values were stable during the whole study at normal values. Due to strict ethic obligations, the study was stopped after 3 patients worsening under study conditions.

Correct respiratory sensing and signalling is needed for controlling OSA using UAS. Therefore implanting centres should continue to achieve perfect respiratory sensing during implantation and therapy adjustment with the utmost diligence.

Publication History

Publication Date:
23 April 2019 (online)