Bibliographie - Aventri€¦ · 6: Schwartz AR, Barnes M, Hillman D, Malhotra A, Kezirian E, Smith...

Stimulation de l’hypoglosse

Bibliographie

Pierre-Jean Monteyrol – Bordeaux

Frédéric Chabolle – Hôpital Foch - Suresnes

mots clés pub med hypoglossal nerve- stimulation- apneas

Resultats: 67 retenus : 14

1: Yang TF, Jin XJ. [Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea hypopnea syndrome]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Aug;47(8):698-701. Chinese. 2: Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH. Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med. 2013 May 15;9(5):433-8. doi: 10.5664/jcsm.2658.. 3: Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, Hohenhorst W, Knaack L, Lin HS, Maurer JT, Netzer A, Odland RM, Oliven A, Strohl KP, Vanderveken OM, Verbraecken J, Woodson BT. Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope. 2012 Jul;122(7):1626-33. doi: 10.1002/lary.23301. Epub 2012 May 1. 4: Rosario IC. Obstructive sleep apnea: a review and update. Minn Med. 2011 Nov;94(11):44-8. Review. 5: Goding GS Jr, Tesfayesus W, Kezirian EJ. Hypoglossal nerve stimulation and airway changes under fluoroscopy. Otolaryngol Head Neck Surg. 2012 Jun;146(6):1017-22. doi: 10.1177/0194599812436472. Epub 2012 Feb 3. PubMed PMID: 22307575. 6: Schwartz AR, Barnes M, Hillman D, Malhotra A, Kezirian E, Smith PL, Hoegh T, Parrish D, Eastwood PR. Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea. Am J Respir Crit Care Med. 2012 Feb 15;185(4):420-6. doi: 10.1164/rccm.201109-1614OC. Epub 2011 Dec 1.

Eastwood PR, Barnes M, Walsh JH, Maddison KJ, Hee G, Schwartz AR, Smith PL,Malhotra A, McEvoy RD, Wheatley JR,

O'Donoghue FJ, Rochford PD, Churchward T, Campbell MC, Palme CE, Robinson S, Goding GS, Eckert DJ, Jordan AS, Catcheside PG, Tyler L, Antic NA, Worsnop CJ, Kezirian EJ, Hillman DR. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep. 2011 Nov 1;34(11):1479-86. doi: 10.5665/sleep.1380. 8: Kuna ST. Back to the future or forward to the past? Sleep. 2011 Nov 1;34(11):1455-6. doi: 10.5665/sleep.1370. PubMed PMID: 22043113; PubMed Central 9: Oliven A. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Curr Opin Pulm Med. 2011 Nov;17(6):419-24. doi: 10.1097/MCP.0b013e32834b7e65. Review. 10: Fregosi RF. Influence of tongue muscle contraction and transmural pressure on nasopharyngeal geometry in the rat. J Appl Physiol. 2011 Sep;111(3):766-74. doi: 10.1152/japplphysiol.01501.2010. Epub 2011 Jun 30. PubMed PMID: 21719721; 11: Liu YH, Huang Y, Shao X. Effects of estrogen on genioglossal muscle contractile properties and fiber-type distribution in chronic intermittent hypoxia rats. Eur J Oral Sci. 2009 Dec;117(6):685-90. doi: 10.1111/j.1600-0722.2009.00681.x 12: Kezirian EJ, Boudewyns A, Eisele DW, Schwartz AR, Smith PL, Van de Heyning PH, De Backer WA. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Med Rev. 2010 Oct;14(5):299-305. doi: 10.1016/j.smrv.2009.10.009. Epub 2010 Jan 29. 13: Oliven R, Tov N, Odeh M, Gaitini L, Steinfeld U, Schwartz AR, Oliven A. Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea. J Appl Physiol. 2009 May;106(5):1668-73. doi: 10.1152/japplphysiol.91501.2008. Epub 2009 Feb 19. 14: Budzinska K, Ilasz R. Electroencephalographic and respiratory activities during acute intermittent hypoxia in anesthetized rats. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 1):85-93.

Historique

• Le 1er système a été mis en place par Guilleminault C, Hill MW, Simmons FB, Dement WC. Obstructive sleep apnea: electromyographic and fiberoptic studies. Exp Neurol 1978;62:48–67.

• Puis 10 ans plus tard Miki H Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea. Am Rev Respir Dis 1989;140:1285–9.

• Confirmation ensuite par Hida W, Takishima T. The effect of submental electrical stimulation on sleep disordered breathing in patients with obstructive sleep apnea. Sleep 1993;16:S96–7.

• Efficace mais eveillant Guilleminault C, The effect of electrical stimulation on obstructive sleep apnea syndrome. Chest 1995;107:67–73.

• Efficace non eveillant Smith PL, Eisele DW, Podszus T, Penzel T, Grote L, Peter JH, et al. Electrical stimulation of upper airway musculature. Sleep 1996;19:S284–7.

• Obtention des 1ers resultats probants Schwartz AR, Electrical stimulation of the lingual musculature in obstructive sleep apnea. J Appl Physiol 1996;81:643–52.

• Impacts electriques avec protrusion plus efficace Oliven A,. Effect of coactivation of tongue protrusor and retractor muscles on pharyngeal lumen and airflow in sleep apnea. J Appl Physiol 2007;103:1662–8.

• Reponse sous popofol Oliven A,. Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J 2007;30:1–11.

Obstructive sleep apnea: Electromyographic and fiberoptic studies

Christian Guilleminault Experimental Neurology, October 1978

17 SAOS 4 contrôles

P.S.G. Nasofibroscopie (NFS).film continue Nuit et jour

Electrodes de recueil

Constatations NFS l’apnée apparait pendant une invagination du mur postéro latéral du pharynx En EMG si non SAOS = normal si SAOS hypotonie musculaire

Conclusion

En obstruction pendant le sommeil l’activité des muscles pharyngés s’oppose a la P <O inspiratoire Efficace mais éveillant

The Effect of Electrical Stimulation on Obstructive Sleep Apnea Syndrome

Christian Guilleminault; Nelson Powell Chest 1995; 107:67-78

……Each time a breakage of apnea was noted, it was associated with a time linked alpha EEG arousal. The results obtained by us and others do not, at this time, give convincing support for the use of electrical stimulation using submental surface or intraoral electrodes as a viable approach for effective control of obstructive sleep apnea syndrome symptoms.

Effects of Submental Electrical Stimulation during Sleep on Upper Airway Patency in Patients with Obstructive Sleep Apnea

Hiroshi Miki American Review of Respiratory Disease1989

Effets de la stimulation percutanée sur 6 SAOS PSG ES avec et sans 0,5ms à 50Htz avec de 15 à 40v si apnée > 5sec Effets de la stimulation - IAH - durée apnée la plus longue

Conclusion Effets sur SAOS de la stimulation percutanée sous mentale ↑ Temps de sommeil ↓durée apnée la plus longue ↓ t SaO²< 85% ↓ IAH Sans réveiller le patient Niveau 3

A. R. Schwartz 1996 J Applied Physiology

Electrical stimulation of the lingual musculature in obstructive sleep apnoea

9 SAOS Rétracteurs hyo et stylo glosses Propulseurs génio-glosse Stimulation 50 Htz-40msec sans effet éveillant Effet de l’intensité la plus forte sur LD Si stimulation en inspiration sur - rétracteur ventilation minute ↓239 ml/s - protracteurs vent/min ↑217ml/s

Conclusion La stimulation des muscles linguaux peut augmenter ou diminuer la ventilation selon l’impact sans réveiller le patient Obtention des premiers résultats probants Niveau 3

8 SAOS implantés Stimulation unilatérale en inspiration Controles à 1-3-6 mois NREM IAH 5222 Preuve de la faisabilité

Récente études ont montré que la stimulation musculaire du génio-glosse et celle du nerf hypoglosse peuvent être effectues de façon sure Il espère alors que des études futures verront le jour

Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea

Arie Oliven J Appl Physiol 95: 2023–2029, 2003;

Neural prosthesis for obstructive sleep apnea.

Yoo P, Durand D Conf Proc IEEE Eng Med Biol Soc. 2005;5:5254-6.

Electrical stimulation of the hypoglossal (XII) nerve has been demonstrated as an effective approach to treating obstructive sleep apnea (OSA). The physiological effects of conventional modes of stimulation (i.e., genioglossus activation or whole XII nerve stimulation), however, have yielded inconsistent and only partial alleviations of hypoapneic or apneic events. While selective stimulation of the multi-fasciculated XII nerve offers many stimulus options, it is not clear how they will functionally affect the upper airway (UAW). To study these effects, animal experiments in four beagles

were performed to investigate changes in critical pressure (Pcrit), during inspiration. For simulated inspiration, only whole XII nerve stimulation (-0.9 ± 0.4 cmH2O) and co-activation of the GG + HG/SG muscles (-1.18 ± 0.6 cmH2O) produced significant (p < 0.05) improvements in UAW stability (i.e., lowered Pcrit), compared to baseline (-0.52 ± 0.32 cmH2O). The results of this study suggest that a multi-contact nerve electrode can achieve both UAW dilation and patency, comparable to that obtained with non-selective stimulation by selectively activating the various branches of the XII nerve

Si stimulation du nerf en masse alors il faut utiliser des multi electrodes

Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients

Eur Respir J.2007 Oct;30(4):748-58 Oliven A

Oropharynx velopharynx

PPC PPC

ES ES

10 cm

d’H²O

6 4

Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea

Kezirian Schwartz Sleep Med Rev. 2010 Oct;14(5):299-305

SAOS…..has been attributed to a decline in pharyngeal neuromuscular activity occurring in a structurally narrowed airway. Surgical treatment focuses on the correction of anatomic abnormalities, but there is a potential role for activation of the upper airway musculature, especially with stimulation of the hypoglossal nerve and genioglossus muscle. We present evidence from research on upper airway neuromuscular electrical stimulation in animals and humans. We also present results from eight obstructive sleep apnea patients with a fully implanted system for hypoglossal nerve stimulation, demonstrating an improvement in upper airway collapsibility and obstructive sleep apnea severity. Future research,……alternative to positive airway pressure therapy and upper airway surgical procedures

La 1ère étude qui démontre l’intérêt de la stimulation électrique clinique qui agit sur l’activité tonique et phasique des muscles responsables de la perméabilité des VADS pendant le sommeil


Eric J. Kezirian Sleep Medicine Reviews 14 (2010) 299–305


Kezirian Schwartz Sleep Med Rev. 2010 Oct;14(5):299-305

Stim>o

Effets dans le temps sur IAH

Unilateral hypoglossal nerve stimulation results

on tongue base and retrolingual - anterior tongue base displacement - an increase in the anterior-posterior retrolingual airway dimensions of the pharynx, - independent of body mass index

on retropalatal - an opening of the retropalatal airway in a majority of subjects - correlation with body mass index

Hypoglossal nerve stimulation and airway changes under fluoroscopy.

Otolaryngol Head Neck Surg. 2012 Goding GS Jr

Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea

Y. Dotan Eur Respir J 2011; 38: 338–347



GGa tout le GG

GGp fibres hor

Treating Obstructive Sleep Apnea with Hypoglossal Nerve Stimulation

Peter R. Eastwood, PhD SLEEP 2011;34(11):1479-1486

Conclusions: HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. Niveau 4

HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement.

HGNS, Apnex Medical, Inc

Treating Obstructive Sleep Apnea with Hypoglossal Nerve Stimulation

Peter R. Eastwood, PhD SLEEP 2011;34(11):1479-1486

Conclusions: HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. Niveau 4

HGNS, Apnex Medical, Inc

AHI (43.1 ± 17.5 to 19.5 ± 16.7

Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea

Alan R. Schwartz AJRCCM December 1, 2011

Supported by Apnex Medical, Inc.

Methods: Responses were examined in thirty patients with sleep apnea who were implanted with an HGNS® system. Current (mA) was increased stepwise during non-REM sleep. Frequency and pulse width were fixed. At each current level, stimulation was applied on alternating breaths, and responses in maximal inspiratory airflow (VImax) and inspiratory airflow limitation (IFL) were assessed. Pharyngeal responses to HGNS were characterized by the (a) current levels at which VImax first increased and peaked (flow capture and peak flow thresholds), and the (b) VImax increase from flow capture to peak (VImax). Results: HGNS produced linear increases in VImax from unstimulated levels at flow capture to peak flow thresholds (215±21 to 509±37mL/s, mean±SE, p<0.001) with increasing current from 1.05±0.09 to 1.46±0.11mA. VImax increased in all patients and IFL was abolished in 57% of patients (non-IFL subgroup). In the non-IFL compared to IFL subgroup, the flow response slope was greater (1241±199 vs. 674±166mL/s/mA, p<0.05) and the stimulation amplitude at peak flow was lower (1.23±0.10 vs. 1.80±0.20mA, p<0.05) without differences in peak flow.

Conclusions: HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in the majority of patients and both IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.

Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea

Alan R. Schwartz AJRCCM December 1, 2011

Supported by Apnex Medical, Inc.

Targeted hypoglossal neurostimulation for obstructive sleep apnoea: a 1-year pilot study

Eur Respir J. 2013 Feb;41(2):360-7 Mwenge GB

A multi-contact electrode positioned around the main trunk of the twelfth nerve The primary objective was to improve the polysomnographically determined apnoea/hypopnoea index (AHI) at 3 months, and maintain the improvement after 12 months of treatment 13 out of 14 operated IAH = 45 18 to 21 17, a 53% reduction (p<0.001) SaO² =4% oxygen desaturation 29 20 to 15 16 arousal index = 37 13 to 25 14, both p<0.001 Epworth sleepiness scale = 11 7 to 8 4 (p=0.09).

Laryngoscope, 122:1626–1633, 2012

The current study has demonstrated that therapy with upper airway stimulation is safe and efficacious in a select group of patients with moderate to severe OSA who cannot or will not use CPAP as primary treatment. Level of Evidence: 4.

Laryngoscope, 122:1626–1633, 2012

Les répondeurs sont IMC et IAH plus bas

Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea.

Vanderveken OM . J Clin Sleep Med 2013;9(5)

The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy. DISE can be recommended as a patient selection tool for implanted UAS to treat OSA

AP CCC

SAFETY AND EFFICACY OF UPPER AIRWAY STIMULATION IN TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Strollo PJ1, Soose RJ2, Strohl KP3

Results: 126 participants (21 females) age 54.5 10.2 yrs BMI was 28.4 2.6 kg/m2. 12 months AHI 29.3 to 9.0 Oxygen Desaturation Index 25.4 to 7.4 The ESS and FOSQ also showed significant improvement from pre-implant to 12 months. The therapeutic effect of stimulation was also confirmed at 12 months with a significant increase in AHI in the therapy withdrawal arm vs. no change in the therapy maintenance arm. Conclusion: Upper airway stimulation is effective for the treatment of moderate to severe OSA with clinically and statistically significant improvement in objective and subjective measurements of OSA severity. Support: Inspire Medical Systems, Minnesota

BALTIMORE JUIN 2013

Operative technique of upper airway stimulation: an implantable treatment of obstructive sleep apnea

Joachim T. Maurer Operative Techniques in Otolaryngology (2012)

Bibliographie - Aventri€¦ · 6: Schwartz AR, Barnes M, Hillman D, Malhotra A, Kezirian E, Smith...

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