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Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study
Purpose Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of periphera...
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| Published in: | Sleep & breathing 2019-03, Vol.23 (1), p.153-160 |
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| container_title | Sleep & breathing |
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| creator | Ikeda, Allison K. Li, Qiao Quyuumi, Arshed A. Dedhia, Raj C. |
| description | Purpose
Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography.
Methods
Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed.
Results
Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5,
p
= 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (
R
2
= |
| doi_str_mv | 10.1007/s11325-018-1676-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2057870605</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2057291943</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-7bf0edf639003fd5e451f09e73d31c8c46169a23882687a92f072c07e599f5d03</originalsourceid><addsrcrecordid>eNp1kcFrFTEQxoNYbK3-AV4k4MXL2pnkZbPxJkWtUPDSnkPe7mzdkt3EJCvsf9-8vqogeMo35DffDPMx9gbhAwLoi4wohWoAuwZb3TbmGTtDJUSDGszzRw2NUShO2cuc7wFw1xl8wU6FMaKVRp2xeLXFcOdDzs7zhdIv4rlM8-pdmcLCyw9KLm68ykhpiofSc5dKLaooYQkzlbTxaeFhn0ta-zIdPDxR5C4u5D5yx-PkQ6nG67C9Yiej85leP73n7PbL55vLq-b6-9dvl5-um15qURq9H4GGsS4JIMdB0U7hCIa0HCT2Xb9rsTVOyK4TbaedESNo0YMmZcyoBpDn7P3RN6bwc6Vc7Dzlnrx3C4U1WwFKdxpaUBV99w96H9a01O0eKWHQ7GSl8Ej1qV4r0WhjmmaXNotgD3HYYxy2xmEPcVhTe94-Oa_7mYY_Hb_vXwFxBHL9Wu4o_R39f9cHgi6WUw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2057291943</pqid></control><display><type>article</type><title>Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study</title><source>Social Science Premium Collection</source><source>Springer Link</source><creator>Ikeda, Allison K. ; Li, Qiao ; Quyuumi, Arshed A. ; Dedhia, Raj C.</creator><creatorcontrib>Ikeda, Allison K. ; Li, Qiao ; Quyuumi, Arshed A. ; Dedhia, Raj C.</creatorcontrib><description>Purpose
Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography.
Methods
Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed.
Results
Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5,
p
= 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (
R
2
= <0.12). Across all subjects, poor linear correlation was present between HGNS and PAT signal attenuation (
R
2
= 0.028) in both adjusted and unadjusted analyses.
Conclusions
Using PAT-integrated polysomnography, PAT output does not appear to be affected by HGNS stimulation at clinical thresholds. These findings support the absence of autonomic system alterations by twelfth nerve stimulation and support the clinical use of PAT-based devices for post-HGNS monitoring. Larger studies examining hard cardiovascular endpoints with HGNS are needed.</description><identifier>ISSN: 1520-9512</identifier><identifier>EISSN: 1522-1709</identifier><identifier>DOI: 10.1007/s11325-018-1676-9</identifier><identifier>PMID: 29926395</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Apnea ; Arousal ; Autonomic nervous system ; Autonomic Nervous System - physiology ; Cardiovascular diseases ; Dentistry ; Electric Stimulation Therapy - methods ; Female ; Humans ; Hypoglossal Nerve ; Internal Medicine ; Male ; Manometry - methods ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Otorhinolaryngology ; Pediatrics ; Pilot Projects ; Pneumology/Respiratory System ; Polysomnography - instrumentation ; Sleep ; Sleep apnea ; Sleep Apnea, Obstructive - therapy ; Sleep Breathing Physiology and Disorders • Original Article ; Sleep disorders ; Titration</subject><ispartof>Sleep & breathing, 2019-03, Vol.23 (1), p.153-160</ispartof><rights>Springer International Publishing AG, part of Springer Nature 2018</rights><rights>Sleep and Breathing is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-7bf0edf639003fd5e451f09e73d31c8c46169a23882687a92f072c07e599f5d03</citedby><cites>FETCH-LOGICAL-c372t-7bf0edf639003fd5e451f09e73d31c8c46169a23882687a92f072c07e599f5d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2057291943/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2057291943?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21394,27924,27925,33611,33612,43733,74221</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29926395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ikeda, Allison K.</creatorcontrib><creatorcontrib>Li, Qiao</creatorcontrib><creatorcontrib>Quyuumi, Arshed A.</creatorcontrib><creatorcontrib>Dedhia, Raj C.</creatorcontrib><title>Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study</title><title>Sleep & breathing</title><addtitle>Sleep Breath</addtitle><addtitle>Sleep Breath</addtitle><description>Purpose
Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography.
Methods
Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed.
Results
Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5,
p
= 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (
R
2
= <0.12). Across all subjects, poor linear correlation was present between HGNS and PAT signal attenuation (
R
2
= 0.028) in both adjusted and unadjusted analyses.
Conclusions
Using PAT-integrated polysomnography, PAT output does not appear to be affected by HGNS stimulation at clinical thresholds. These findings support the absence of autonomic system alterations by twelfth nerve stimulation and support the clinical use of PAT-based devices for post-HGNS monitoring. Larger studies examining hard cardiovascular endpoints with HGNS are needed.</description><subject>Aged</subject><subject>Apnea</subject><subject>Arousal</subject><subject>Autonomic nervous system</subject><subject>Autonomic Nervous System - physiology</subject><subject>Cardiovascular diseases</subject><subject>Dentistry</subject><subject>Electric Stimulation Therapy - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoglossal Nerve</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Manometry - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Otorhinolaryngology</subject><subject>Pediatrics</subject><subject>Pilot Projects</subject><subject>Pneumology/Respiratory System</subject><subject>Polysomnography - instrumentation</subject><subject>Sleep</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>Sleep Breathing Physiology and Disorders • Original Article</subject><subject>Sleep disorders</subject><subject>Titration</subject><issn>1520-9512</issn><issn>1522-1709</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>M2R</sourceid><recordid>eNp1kcFrFTEQxoNYbK3-AV4k4MXL2pnkZbPxJkWtUPDSnkPe7mzdkt3EJCvsf9-8vqogeMo35DffDPMx9gbhAwLoi4wohWoAuwZb3TbmGTtDJUSDGszzRw2NUShO2cuc7wFw1xl8wU6FMaKVRp2xeLXFcOdDzs7zhdIv4rlM8-pdmcLCyw9KLm68ykhpiofSc5dKLaooYQkzlbTxaeFhn0ta-zIdPDxR5C4u5D5yx-PkQ6nG67C9Yiej85leP73n7PbL55vLq-b6-9dvl5-um15qURq9H4GGsS4JIMdB0U7hCIa0HCT2Xb9rsTVOyK4TbaedESNo0YMmZcyoBpDn7P3RN6bwc6Vc7Dzlnrx3C4U1WwFKdxpaUBV99w96H9a01O0eKWHQ7GSl8Ej1qV4r0WhjmmaXNotgD3HYYxy2xmEPcVhTe94-Oa_7mYY_Hb_vXwFxBHL9Wu4o_R39f9cHgi6WUw</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Ikeda, Allison K.</creator><creator>Li, Qiao</creator><creator>Quyuumi, Arshed A.</creator><creator>Dedhia, Raj C.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7T5</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88J</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2R</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20190301</creationdate><title>Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study</title><author>Ikeda, Allison K. ; Li, Qiao ; Quyuumi, Arshed A. ; Dedhia, Raj C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-7bf0edf639003fd5e451f09e73d31c8c46169a23882687a92f072c07e599f5d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Apnea</topic><topic>Arousal</topic><topic>Autonomic nervous system</topic><topic>Autonomic Nervous System - physiology</topic><topic>Cardiovascular diseases</topic><topic>Dentistry</topic><topic>Electric Stimulation Therapy - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoglossal Nerve</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Manometry - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Otorhinolaryngology</topic><topic>Pediatrics</topic><topic>Pilot Projects</topic><topic>Pneumology/Respiratory System</topic><topic>Polysomnography - instrumentation</topic><topic>Sleep</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - therapy</topic><topic>Sleep Breathing Physiology and Disorders • Original Article</topic><topic>Sleep disorders</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ikeda, Allison K.</creatorcontrib><creatorcontrib>Li, Qiao</creatorcontrib><creatorcontrib>Quyuumi, Arshed A.</creatorcontrib><creatorcontrib>Dedhia, Raj C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Social Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Sleep & breathing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ikeda, Allison K.</au><au>Li, Qiao</au><au>Quyuumi, Arshed A.</au><au>Dedhia, Raj C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study</atitle><jtitle>Sleep & breathing</jtitle><stitle>Sleep Breath</stitle><addtitle>Sleep Breath</addtitle><date>2019-03-01</date><risdate>2019</risdate><volume>23</volume><issue>1</issue><spage>153</spage><epage>160</epage><pages>153-160</pages><issn>1520-9512</issn><eissn>1522-1709</eissn><abstract>Purpose
Hypoglossal nerve stimulation (HGNS) is being increasingly utilized in the setting of moderate-severe obstructive sleep apnea (OSA). While moderate-severe OSA confers excess cardiovascular risk, the impact of HGNS on cardiovascular requires further investigation. With the advent of peripheral arterial tonometry (PAT), one can non-invasively study real-time changes to the autonomic nervous system. This study evaluates the effect of HGNS therapy on autonomic output, using PAT-integrated polysomnography.
Methods
Subjects included adult patients undergoing 2-month post-operative HGNS titration studies with PAT-integrated polysomnography. Apneic and hypopneic events with arousal during stage 2 sleep were identified at increasing levels of stimulation. With each event, PAT signal attenuations were recorded, processed, and analyzed.
Results
Nine subjects were enrolled, and eight met inclusion criteria (mean age 67.8 ± 12.4 years; 50% female). The PAT signal did not significantly change before and during stimulation (mean pre-stimulation 43.4 ± 1.7, mean intra-stimulation 41.1 ± 22.5,
p
= 0.53) in any patient. The ratio of the PAT signal maximum and minimum amplitudes during sleep breathing events largely demonstrated very weak correlation (
R
2
= <0.12). Across all subjects, poor linear correlation was present between HGNS and PAT signal attenuation (
R
2
= 0.028) in both adjusted and unadjusted analyses.
Conclusions
Using PAT-integrated polysomnography, PAT output does not appear to be affected by HGNS stimulation at clinical thresholds. These findings support the absence of autonomic system alterations by twelfth nerve stimulation and support the clinical use of PAT-based devices for post-HGNS monitoring. Larger studies examining hard cardiovascular endpoints with HGNS are needed.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29926395</pmid><doi>10.1007/s11325-018-1676-9</doi><tpages>8</tpages></addata></record> |
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| source | Social Science Premium Collection; Springer Link |
| subjects | Aged Apnea Arousal Autonomic nervous system Autonomic Nervous System - physiology Cardiovascular diseases Dentistry Electric Stimulation Therapy - methods Female Humans Hypoglossal Nerve Internal Medicine Male Manometry - methods Medicine Medicine & Public Health Middle Aged Neurology Otorhinolaryngology Pediatrics Pilot Projects Pneumology/Respiratory System Polysomnography - instrumentation Sleep Sleep apnea Sleep Apnea, Obstructive - therapy Sleep Breathing Physiology and Disorders • Original Article Sleep disorders Titration |
| title | Hypoglossal nerve stimulation therapy on peripheral arterial tonometry in obstructive sleep apnea: a pilot study |
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