Skip to main content
Top
Published in: Sleep and Breathing 4/2021

01-12-2021 | Snoring | Sleep Breathing Physiology and Disorders • Original Article

A novel intraoral neuromuscular stimulation device for treating sleep-disordered breathing

Authors: Bhik Kotecha, Phui Yee Wong, Henry Zhang, Amro Hassaan

Published in: Sleep and Breathing | Issue 4/2021

Login to get access

Abstract

Purpose

To ascertain the usefulness of a novel intraoral neuromuscular stimulation device in treating patients with primary snoring and mild obstructive sleep apnoea (OSA). This device uses daytime awake neuromuscular electrical stimulation (NMES) as an application to induce toning of the tongue muscles.

Methods

A prospective cohort study of 70 patients with sleep-disordered breathing was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive night WatchPat sleep studies before and after treatment. The device was used for 20 min once daily for a 6-week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded. Quality of life parameters were also noted.

Results

Objective reduction of snoring was noted on the sleep studies in 95% of participants, with an average snoring time reduction of 48%. Subjectively, the visual analogue scale reported by partners’ similarly demonstrated reduction in 95% of the patients with an average reduction of 40%. In a subset of 38 patients with mild OSA, AHI reduced from 9.8 to 4.7/h (52% reduction), ODI 7.8 to 4.3/h (45% reduction), and ESS from 9.0 to 5.1. Adverse effects encountered were minimal.

Conclusion

This prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and mild OSA in both simple snorers and patients with mild OSA. This device offers a safe and novel approach to reduce snoring and mild OSA by utilising intraoral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep.

Trial registration

Literature
1.
go back to reference White DP (1995) Sleep-related breathing disorder: 2—pathophysiology of obstructive sleep apnoea. Thorax. 50:797–804CrossRef White DP (1995) Sleep-related breathing disorder: 2—pathophysiology of obstructive sleep apnoea. Thorax. 50:797–804CrossRef
2.
go back to reference Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ et al (2008 Aug) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071e8 Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ et al (2008 Aug) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071e8
3.
go back to reference Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 122:352–360CrossRef Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 122:352–360CrossRef
4.
go back to reference Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041CrossRef Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041CrossRef
5.
go back to reference Peppard PE, Szklo-Coxe M, Hla KM, Young T (2006) Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med 166:1709–1715CrossRef Peppard PE, Szklo-Coxe M, Hla KM, Young T (2006) Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med 166:1709–1715CrossRef
7.
go back to reference Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310e8CrossRef Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310e8CrossRef
8.
go back to reference Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006e14CrossRef Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006e14CrossRef
9.
go back to reference Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Repir Med 7:687–698CrossRef Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Repir Med 7:687–698CrossRef
10.
go back to reference Neelapu BC, Kharbanda OP, Sardana HK et al (2017) Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 31:79e90CrossRef Neelapu BC, Kharbanda OP, Sardana HK et al (2017) Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 31:79e90CrossRef
11.
go back to reference Dempsey JA, Xie A, Patz DS et al (2014) Physiology in medicine: obstructive sleep apnea pathogenesis and treatment considerations beyond airway anatomy. J Appl Physiol 116:3e12 Dempsey JA, Xie A, Patz DS et al (2014) Physiology in medicine: obstructive sleep apnea pathogenesis and treatment considerations beyond airway anatomy. J Appl Physiol 116:3e12
12.
go back to reference Eckert DJ, White DP, Jordan AS et al (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188:996e1004CrossRef Eckert DJ, White DP, Jordan AS et al (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188:996e1004CrossRef
13.
go back to reference Wilkinson V, Malhotra A, Nicholas CL et al (2008) Discharge patterns of human genioglossus motor units during sleep onset. Sleep 31:525e33CrossRef Wilkinson V, Malhotra A, Nicholas CL et al (2008) Discharge patterns of human genioglossus motor units during sleep onset. Sleep 31:525e33CrossRef
14.
go back to reference Ferguson M, Magill JC, Kotecha BT (2017) Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea. Ther Adv Respir Dis 11:411–423CrossRef Ferguson M, Magill JC, Kotecha BT (2017) Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea. Ther Adv Respir Dis 11:411–423CrossRef
16.
go back to reference Virk JS, Kotecha B (2016) Otorhinolaryngological aspects of sleep-related breathing disorders. J Thorac Dis 8:213–223CrossRef Virk JS, Kotecha B (2016) Otorhinolaryngological aspects of sleep-related breathing disorders. J Thorac Dis 8:213–223CrossRef
17.
go back to reference Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370:139–149CrossRef Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370:139–149CrossRef
18.
go back to reference Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 38(5):669–675CrossRef Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015) Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 38(5):669–675CrossRef
19.
go back to reference Sillen MJ1, Franssen FM, Gosker HR et al (2013) Metabolic and structural changes in lower-limb skeletal muscle following neuromuscular electrical stimulation: a systematic review. PLoS One 8(9):e69391CrossRef Sillen MJ1, Franssen FM, Gosker HR et al (2013) Metabolic and structural changes in lower-limb skeletal muscle following neuromuscular electrical stimulation: a systematic review. PLoS One 8(9):e69391CrossRef
20.
go back to reference Wiltfang J, Klotz S, Wiltfang J, Jordan W, Cohrs S, Engelbe W, Hajak G (1999) First results on daytime submandibular electrostimulation of suprahyoidal muscles to prevent night-time hypopharyngeal collapse in obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg 28(1):21–25CrossRef Wiltfang J, Klotz S, Wiltfang J, Jordan W, Cohrs S, Engelbe W, Hajak G (1999) First results on daytime submandibular electrostimulation of suprahyoidal muscles to prevent night-time hypopharyngeal collapse in obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg 28(1):21–25CrossRef
21.
go back to reference Verse T, Schwalb J, Hörmann K et al (2003) Submental transcutaneous electrical stimulation for obstructive sleep apnea. HNO. 51(12):966–970CrossRef Verse T, Schwalb J, Hörmann K et al (2003) Submental transcutaneous electrical stimulation for obstructive sleep apnea. HNO. 51(12):966–970CrossRef
23.
go back to reference Pae EK, Hyatt JP, Wu J et al (2007) Short-term electrical stimulation alters tongue muscle fibre type composition. Arch Oral Biol 52(6):544–551CrossRef Pae EK, Hyatt JP, Wu J et al (2007) Short-term electrical stimulation alters tongue muscle fibre type composition. Arch Oral Biol 52(6):544–551CrossRef
24.
go back to reference Zaidi FN, Meadows P, Jacobowitz O, Davidson TM (2013) Tongue anatomy and physiology, the scientific basis for a novel targeted neurostimulation system designed for the treatment of obstructive sleep apnea. Neuromodulation: Journal of the International Neuromodulation Society 16(4):376–386CrossRef Zaidi FN, Meadows P, Jacobowitz O, Davidson TM (2013) Tongue anatomy and physiology, the scientific basis for a novel targeted neurostimulation system designed for the treatment of obstructive sleep apnea. Neuromodulation: Journal of the International Neuromodulation Society 16(4):376–386CrossRef
25.
go back to reference Steier J, Seymor J, Rafferty GF et al (2011) Continuous transcutaneous submental electrical stimulation in obstructive sleep apnea: a feasibility study. Chest 140:998–1007CrossRef Steier J, Seymor J, Rafferty GF et al (2011) Continuous transcutaneous submental electrical stimulation in obstructive sleep apnea: a feasibility study. Chest 140:998–1007CrossRef
Metadata
Title
A novel intraoral neuromuscular stimulation device for treating sleep-disordered breathing
Authors
Bhik Kotecha
Phui Yee Wong
Henry Zhang
Amro Hassaan
Publication date
01-12-2021
Publisher
Springer International Publishing
Keyword
Snoring
Published in
Sleep and Breathing / Issue 4/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-021-02355-7

Other articles of this Issue 4/2021

Sleep and Breathing 4/2021 Go to the issue

Sleep Breathing Physiology and Disorders • Original Article

Association between physical activity and risk of obstructive sleep apnea

Sleep Breathing Physiology and Disorders • Original Article

Association of serum asprosin concentrations with obstructive sleep apnea syndrome

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.