Combination of acute intermittent hypoxia and intermittent transcutaneous electrical stimulation in obstructive sleep apnea: a randomized controlled crossover trial

IF 1.9 4区医学 Q3 PHYSIOLOGY Respiratory Physiology & Neurobiology Pub Date : 2024-06-15 DOI:10.1016/j.resp.2024.104298

Shiqian Zha , Xu Liu , Hao Chen, Yueying Hao, Jingyi Zhang, Qingfeng Zhang, Ke Hu

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Abstract

Intermittent hypoxia (IH) and intermittent transcutaneous electrical stimulation (ITES) might benefit patients with obstructive sleep apnea (OSA). However, the therapeutic value of combined IH and ITES in OSA is unknown. In this prospective, randomized, controlled crossover study, normoxia (air exposure for 50 min before sleep and sham stimulation for 6 h during sleep), IH (5 repeats of 5 min 10–12 % O₂ alternating with 5 min air for 50 min, and sham stimulation for 6 h), ITES (air exposure for 50 min and 6 repeats of 30 min transcutaneous electrical stimulation alternating with 30 min of sham stimulation for 6 h), and IH&ITES (10–12 % O₂ alternating with air for 50 min and transcutaneous electrical stimulation alternating with sham stimulation for 6 h) were administered to patients with OSA over four single-night sessions. The primary endpoint was difference in OSA severity between the interventions according to apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The efficacy was response to IH, ITES, IH&ITES defined as a ≥50 % reduction in AHI compared with normoxia. Twenty participants (17 male, 3 female) completed the trial. The median (IQR) AHI decreased from 14.5 (10.8, 17.5) events/h with normoxia to 6.9 (3.9, 14.8) events/h with IH (p=0.020), 5.7 (3.4, 9.1) events/h with ITES (p=0.001), and 3.5 (1.8, 6.4) events/h with IH&ITES (p=0.001). AHI was significantly different between IH and IH&ITES (p=0.042) but not between ITES and IH&ITES (p=0.850). For mild-moderate OSA (n=17), IH, ITES, and IH&ITES had a significant effect on AHI (p=0.013, p=0.001, p=0.001, respectively) compared with normoxia, but there were no differences in post hoc pairwise comparisons between intervention groups. No serious adverse events were observed. In conclusion, IH, ITES, and IH&ITES significantly reduced OSA severity. IH&ITES showed better efficacy in mild-moderate OSA than IH and was comparable to ITES. Our data do not support recommending IH&ITES over ITES for OSA.

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急性间歇性缺氧与间歇性经皮电刺激相结合治疗阻塞性睡眠呼吸暂停：随机对照交叉试验

间歇性缺氧（IH）和间歇性经皮电刺激（ITES）可能对阻塞性睡眠呼吸暂停（OSA）患者有益。然而，IH 和 ITES 联合疗法对 OSA 的治疗价值尚不清楚。在这项前瞻性、随机对照交叉研究中，分别采用了常氧（睡眠前暴露于空气中 50 分钟，睡眠期间假刺激 6 小时）、IH（50 分钟内重复 5 次 5 分钟 10-12 % O2 的空气刺激，与 5 分钟的空气刺激交替进行，假刺激 6 小时）、ITES（50 分钟内暴露于空气中，6 次重复 30 分钟的经皮电刺激，与 30 分钟的假刺激交替进行，假刺激 6 小时）、IH&.ITES（50 分钟内暴露于空气中，6 次重复 30 分钟的经皮电刺激，与 30 分钟的假刺激交替进行，假刺激 6 小时）；对 OSA 患者进行 ITES（10-12% 的氧气与空气交替照射 50 分钟，经皮电刺激与假刺激交替照射 6 小时），共四个单晚疗程。主要终点是根据呼吸暂停-低通气指数（AHI）和血氧饱和度指数（ODI）得出的干预措施之间 OSA 严重程度的差异。疗效是对 IH、ITES、IH&ITES 的反应，即与常氧相比，AHI 下降≥50%。20 名参与者（17 名男性，3 名女性）完成了试验。AHI的中位数（IQR）从常氧状态下的14.5（10.8，17.5）次/小时降至IH状态下的6.9（3.9，14.8）次/小时（p=0.020）、ITES状态下的5.7（3.4，9.1）次/小时（p=0.001）和IH&ITES状态下的3.5（1.8，6.4）次/小时（p=0.001）。IH 和 IH&ITES 之间的 AHI 有明显差异（p=0.042），但 ITES 和 IH&ITES 之间没有差异（p=0.850）。对于轻度-中度 OSA（n=17），与常氧相比，IH、ITES 和 IH&ITES 对 AHI 有显著影响（分别为 p=0.013、p=0.001、p=0.001），但干预组之间的事后配对比较没有差异。未观察到严重不良事件。总之，IH、ITES和IH&ITES能显著降低OSA的严重程度。IH&ITES对轻度-中度OSA的疗效优于IH，与ITES相当。我们的数据不支持推荐使用 IH&ITES 而非 ITES 治疗 OSA。

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来源期刊

Respiratory Physiology & Neurobiology 医学-呼吸系统

CiteScore

4.80

自引率

8.70%

发文量

104

审稿时长

54 days

期刊介绍： Respiratory Physiology & Neurobiology (RESPNB) publishes original articles and invited reviews concerning physiology and pathophysiology of respiration in its broadest sense. Although a special focus is on topics in neurobiology, high quality papers in respiratory molecular and cellular biology are also welcome, as are high-quality papers in traditional areas, such as: -Mechanics of breathing- Gas exchange and acid-base balance- Respiration at rest and exercise- Respiration in unusual conditions, like high or low pressure or changes of temperature, low ambient oxygen- Embryonic and adult respiration- Comparative respiratory physiology. Papers on clinical aspects, original methods, as well as theoretical papers are also considered as long as they foster the understanding of respiratory physiology and pathophysiology.