الفهرس 
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Abstract
The principal evidence-based treatment of obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) that requires constant use to avoid recurrence of symptoms and the potential for any negative consequences. However, patients often find it difficult to get used to this device over long periods, with a quarter of patients being non-compliant within weeks and half of them not using this type of equipment after one year.
Electrical stimulation has been used as an emerging and promising treatment alternative for patients with OSA. This involves applying low current to stimulate the neuromuscular tone of the pharyngeal dilator muscles of the upper airways while asleep.
This study was performed on 27 mild-to moderate OSA patients who had presented to the Lane Fox Unit and the Sleep Disorders Centre at Guy’s & St Thomas’ NHS Foundation Trust, London, UK between July 2018, and March 2020. The study was conducted aiming at evaluation of the efficacy and safety of a domiciliary method of transcutaneous electrical stimulation among OSA patients using the (TENS) device for 3-months duration in comparison to CPAP treatment.
Outcome parameters were the reduction in severity of OSA at 12-weeks compared to baseline, as defined by the apnea-hypopnea index (AHI) and/or 4% oxygen desaturation index (4%ODI) as primary outcomes. A response to treatment was considered as >50% reduction in AHI from baseline and a total AHI< 20/h, and/or reduction >25% in the ODI. Study also assessed patient’s comfort, compliance, and acceptance to the TENS device as secondary outcomes.
All patients recruited to the study had been subjected to the following:
- Medical history taking, assessment of associated comorbidities and physical examination.
- Laboratory investigations such as (CBC, HbA1c and Thyroid function tests).
- Spirometry and ABG.
- Sleep questionnaires (ESS, FOSQ and patient acceptance analogue scale).
- Sonographic assessment of upper airway.
- Baseline sleep study.
Then all patients were randomized into either of the two treatment groups, CPAP or TENS for 12 weeks. Thirteen patients (48%) used auto-CPAP with mean pressure 9.2 (1.2) cmH2O, and 14 (52%) were randomized to use TENS machine with the electrical current of 30 Hz, 250 µsec width and mean intensity of 10.9 (1.1) mA that achieve muscle contraction and varies according to patient’s individual perception of the current.
PSG findings have shown some changes with the use of TENS machine, mean current 10.9 (1.1) mA, and median 5(4.2-6) hours of use /night. Mean TST significantly increased from 366 to 426 minutes (p=0.008*). Mean REM stage %TST was significantly increased from 12.7 (6.6) % to 17.7 (8.7) % (p=0.031*). As regard to respiratory events, median AHI and median 4%ODI were significantly improved at the end of 12 weeks of treatment (12.7 vs 8.2, p=0.001*, 6.5 vs 5.2, p=0.003*, respectively). Significant reductions in frequency of apneas and hypopneas, mean and maximum duration of hypopnea, REM index and minimum SpO2. No adverse events were recorded.