A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults

Optimizing treatment of the novel intra-oral negative pressure for obstructive sleep apnea

STUDY OBJECTIVES

Intra-oral negative pressure therapy (OPT) for obstructive apnea delivers a negative pressure into the oral cavity to increase the upper airway patency and has been shown as an effective CPAP alternative treatment. Rather than one-size-fits-all pressure, it is believed that individualized titration of the negative pressure is needed to achieve the optimal treatment effectiveness. This study aims to evaluate the outcome of OPT after the pressure titration process.

METHODS

A total of 30 people with OSA (3 females, with baseline AHI 39.59 ± 20.05 events/h) completed the OPT titration PSG study. In the OPT titration study, the pressure of the OPT device (iNAP® Lite, Somnics inc.) started at -40 mmHg. The negative pressure increases at least - 10 mmHg if one or more of the following conditions were met (1) ≧ Two obstruction apnea, (2) ≧ 3 hypopneas, (3) ≧ 5 RERAs, (4) ≧ 3 min of loud snoring. The effect of each pressure adjustment is observed for at least 15 min before the next adjustment. The titration process is stopped if the treatment pressure reaches - 250 mmHg.

RESULTS

The result indicates that 83% of subjects achieve the successful treatment criteria (AHI < 5) under individuals' optimal treatment pressure. The mean AHI reduced by 80% with iNAP treatment compared to baseline (8.17 ± 8.123 vs. 9.59 ± 20.05 events/hr). In addition, the percentage of NREM stage 3 (14.89 ± 10.69 vs. 23.23 ± 12.10) and arousal index (48.47 ± 23.78 vs. 26.23 ± 11.43) were significantly improved after treatment compared to baseline. The effectiveness of the OPT significantly increased after the pressure lower than - 100 mmHg compared to the baseline pressure (66.67% vs. 26.67%; p = 0.0042).

CONCLUSIONS

In this study, the number of apnea and hypopnea decrease in the OSA patients as increases in the given negative pressure. That result shows that increasing intraoral negative pressure would further improve the treatment effectiveness and efficacy of OPT for sleep apnea.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Real-World Experiences of the iNAP® Lite in OSA Adults in Taiwan; Identifier: NCT03559322.

A systematic review of smartphone applications and devices for obstructive sleep apnea

OBJECTIVE

Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing.

METHODS

We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review.

RESULTS

We found 10 smartphone apps that met the inclusion criteria.

CONCLUSIONS

The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable.

Evaluation of efficacy and safety of intraoral negative air pressure device in adults with obstructive sleep apnea in Taiwan

OBJECTIVE

Through this study, we aimed to evaluate the efficacy and safety of the intraoral negative air pressure device (iNAP) in patients with moderate to severe obstructive sleep apnea (OSA) in Taiwan.

DESIGN

Crossover and evaluator-blind, self-control design.

SETTING

Academic medical center.

PATIENTS

A total of 35 patients provided their consent to participate in this study; however, only 34 patients (30 men [87.5%] and four women [12.50%]) were eligible and randomized to the Clinical Cohort and Safety Cohort. The mean age of the 32 evaluable patients (PE cohort) was 47.4 ± 11.2 years, and their mean BMI was 26.5 ± 3.2 kg/m².

MEASUREMENTS AND RESULTS

The clinical response rate was 75% (24/32 patients) comparing the treatment polysomnography values to the baseline values. The mean (±standard deviation) baseline apnea-hypopnea index was 32.0 ± 11.3 events/h, which decreased significantly to 8.7 ± 9.4 events/h. Mo medical device-related adverse event or serious adverse event occurred during the study period.

CONCLUSIONS

Compared with the previous oral pressure therapy device, the iNAP treated approximately three-fourths of the patients with OSA and had a superior comfort and safety profile. Thus, the iNAP device could be an alternative treatment solution for patients with moderate to severe OSA.

Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

BACKGROUND

In intermittent negative airway pressure (iNAP) therapy, soft tissues are reshaped into a forward-resting position, thus reducing airway obstruction during sleep. This study investigated the effect of iNAP therapy that was administered during drug-induced sleep endoscopy with target-controlled infusion (TCI-DISE) in patients with obstructive sleep apnea (OSA) intolerant of continuous positive airway pressure (CPAP) therapy.

METHODS

This prospective case series study included 92 patients with polysomnography (PSG)-confirmed OSA who underwent TCI-DISE with iNAP from January 2018 to February 2020 at a tertiary referral hospital. Upper airway obstruction was evaluated and scored using the velum, oropharynx, tongue base, and epiglottis (VOTE) classification. Obstruction severity was assessed multiple times with the patient in the supine position with or without lateral rotation of the head and the application of iNAP therapy, respectively.

RESULTS

After the application of iNAP therapy in the supine position, obstruction severity decreased significantly: from complete or partial obstruction to partial or no obstruction in 37, 12, and 36 patients (40.2%, 13%, and 39%, respectively) with velar obstruction, oropharyngeal, and tongue base obstruction, respectively. After simultaneously applying iNAP therapy with head rotation, obstruction severity decreased in 47, 43, and 19 patients (51%, 47%, and 21%, respectively) with velar, tongue base, and epiglottic obstruction, respectively.

CONCLUSION

In TCI-DISE, we found that iNAP therapy relieved velar, oropharyngeal, and tongue base obstruction in the supine position in some patients. Moreover, iNAP therapy can be combined with positional therapy to alleviate velar, tongue base, and epiglottic obstruction in some patients. TCI-DISE can also be used to screen the possible responders for iNAP therapy because it is less time consuming than PSG.

Building a model to precisely target the responders of a novel intermittent negative air pressure device-with mechanism definition

OBJECTIVE

Due to the complexity of obstructive sleep apnea syndrome (OSAS), engaging patients in the right treatment poses a constant challenge. A novel oral pressure therapy device, the intermittent negative air pressure Sleep Therapy System (iNAP), has proven to ameliorate respiratory events for OSAS patients. However, the mode of action and the characteristics of its responders are not yet fully understood. Therefore, we have first disclosed the mechanism and provided systemic models to predict the treatment response.

METHODS

Series of imaging studies were carried out to differentiate the anatomical features of iNAP responders versus non-responders. Compatible electroencephalography was used to evaluate sleep status during magnetic resonance imaging (MRI) assessments.

RESULTS

The upper airway volume was statistically widened under the iNAP treatment while patients were naturally asleep (p < 0.05). Negative predictors included several parameters related to oral-tissue redundancy, enlarged middle pharyngeal space, and longer distance of hyoidale to mandibular plane. Positive predictors included larger angulation of sella-articulate-gonion, longer distance of anterior nasal spine to posterior nasal spine, and elongated tongue, which could correspond to the fact that the iNAP had a greater ability to widen the retropalatal region. Furthermore, algorithms developed by these predictors were built to predict treatment response.

CONCLUSIONS

We were able to confirm the effect of the iNAP in widening the upper airway. Anatomic features that can be visually observed or obtained through X-ray films, accompanied with the resulting algorithms, were provided to facilitate physicians' ability to predict patients' treatment response to the iNAP with greater sensitivity and efficiency.