Upper-Airway Stimulation for Obstructive Sleep Apnea
推荐理由
本领域的核心重点文章，SCI被引次数高达707次。本文记录了Inspire Medical Systems公司、相关研究人员和美国食品和药物管理局设计的评估舌下神经刺激疗法有效性的一年期临床试验。试验结果表明舌下神经刺激显著改善了阻塞性睡眠呼吸暂停严重程度的客观和主观指标。同年，FDA批准该疗法用于OSA的治疗。
| 文章简介 | |
|---|---|
| 期刊 | New England Journal of Medicine |
| 发表年份 | 2014 |
| DOI | 10.1056/NEJMoa1308659 |
| 类型 | 研究性工作 |
| 领域 | 神经调控治疗 |
| 引用量 | 1157 |
| 推荐信息 | |
|---|---|
| 推荐人 | 艾力亚尔 |
| 审核 | 马伯志 |
| 推荐小组 | 产品研发小组 |
摘要
Background: Obstructive sleep apnea is associated with considerable health risks. Although continuous positive airway pressure (CPAP) can mitigate these risks, effectiveness can be reduced by inadequate adherence to treatment. We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea. Methods: Using a multicenter, prospective, single-group, cohort design, we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy. The primary outcome measures were the apnea-hypopnea index (AHI; the number of apnea or hypopnea events per hour, with a score of ≥15 indicating moderate-to-severe apnea) and the oxygen desaturation index (ODI; the number of times per hour of sleep that the blood oxygen level drops by ≥4 percentage points from baseline). Secondary outcome measures were the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire (FOSQ), and the percentage of sleep time with the oxygen saturation less than 90%. Consecutive participants with a response were included in a randomized, controlled therapy-withdrawal trial. Results: The study included 126 participants; 83% were men. The mean age was 54.5 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 28.4. The median AHI score at 12 months decreased 68%, from 29.3 events per hour to 9.0 events per hour (P<0.001); the ODI score decreased 70%, from 25.4 events per hour to 7.4 events per hour (P<0.001). Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life. In the randomized phase, the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group (8.9 and 7.2 events per hour, respectively); the AHI score was significantly higher (indicating more severe apnea) among the 23 participants in the therapy-withdrawal group (25.8 vs. 7.6 events per hour, P<0.001). The ODI results followed a similar pattern. The rate of procedure-related serious adverse events was less than 2%. Conclusions: In this uncontrolled cohort study, upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea. (Funded by Inspire Medical Systems; STAR ClinicalTrials.gov number, NCT01161420.).
细分领域
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