For Some Sleep Apnea Patients, Noninvasive Electrical Stimulation May Improve Symptoms

Just 3 months of home-based transcutaneous electrical stimulation improved obstructive sleep apnea (OSA) severity and sleepiness in patients with low adherence to continuous positive airway pressure (CPAP) therapy, according to a study published in eClinicalMedicine.

“Domiciliary transcutaneous electrical stimulation provides a feasible second-line treatment for patients with OSA who have failed usual care, and who respond to the treatment over the first follow up period of about 3 months,” wrote corresponding author Joerg Steier, MD, PhD, of Guy’s & St Thomas’ NHS Foundation Trust in London, United Kingdom, and study coauthors.

The open-label, single-center, phase III trial randomly assigned 29 patients to domiciliary transcutaneous electrical stimulation and 27 patients to usual care (CPAP) for a median 3 months. All participants had an apnea-hypopnea index (AHI) between 5 and 35 events per hour, a body mass index between 18.5 and 32, and a documented lack of adherence to CPAP therapy.

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In unadjusted analysis, the change in AHI after 3 months was −11.5 in favor of the intervention, according to the study. After adjustment for baseline values, change in AHI was −7.0 in favor of the intervention.

“More than a third of the intervention group (34.5%) had a positive response to the intervention, as defined by an improvement in the AHI ≥50%, and more than half when a decrease in the oxygen desaturation index of ≥25% was considered (55.2%),” researchers wrote. “The remaining participants of the intervention group either did not change their AHI significantly compared to their baseline sleep study, or had a slight increase in the AHI at follow up (27.6%), while almost half of the usual care group deteriorated (48.1%).”

After adjustment for baseline values, group differences were −2.6 points for Epworth Sleepiness Scale and −8.3 for oxygen desaturation index, both in favor of the intervention, the study found.

One participant assigned transcutaneous electrical stimulation developed mild headaches and subsequently stopped the intervention. The headaches resolved, researchers reported, and no further adverse events were recorded over the course of the study.

Reference

Ratneswaran D, Cheng M, Nasser E, et al. Domiciliary transcutaneous electrical stimulation in patients with obstructive sleep apnoea and limited adherence to continuous positive airway pressure therapy: a single-centre, open-label, randomised, controlled phase III trial. Published online August 3, 2023. eClinicalMedicine. doi:10.1016/j.eclinm.2023.102112