Transcutaneous Electrical Stimulation Therapy in Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Area of Science:

• Sleep Medicine
• Neuromodulation
• Respiratory Physiology

Background:

• Obstructive sleep apnea (OSA) is a prevalent condition characterized by recurrent upper airway collapse during sleep.
• Current treatments for OSA, such as continuous positive airway pressure (CPAP), face challenges with patient adherence.
• Exploring novel therapeutic modalities like transcutaneous electrical nerve stimulation (TENS) is crucial for managing OSA.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of transcutaneous electrical nerve stimulation (TENS) as a treatment for obstructive sleep apnea (OSA).
• To evaluate the impact of TENS on key polysomnographic parameters in OSA patients.

Main Methods:

• A systematic review of randomized controlled trials, randomized comparisons, and observational studies was conducted using major medical databases (PubMed, Scopus, OVID, Cochrane Library) up to July 2019.
• Meta-analysis was performed on data including the apnea-hypopnea index (AHI), mean oxygen saturation (SaO2), lowest oxygen saturation (LSAT), and arousal index (AI).
• Ten studies with 198 patients (mean age 50.9 years, BMI 29.8 kg/m2, male:female ratio 1.6:1) were included in the analysis.

Main Results:

• Transcutaneous electrical nerve stimulation (TENS) treatment demonstrated a statistically significant reduction in the apnea-hypopnea index (AHI) by 12.9 points (P = .008).
• No statistically significant improvements were observed in mean oxygen saturation (SaO2), lowest oxygen saturation (LSAT), or arousal index (AI) following TENS treatment.
• The heterogeneity of outcome measures prevented an assessment of TENS' impact on patient quality of life.

Conclusions:

• Transcutaneous electrical nerve stimulation (TENS) effectively reduces the apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA) by stimulating upper airway dilator muscles.
• The effects of TENS on oxygen saturation and arousal indices remain inconclusive.
• Further high-quality randomized controlled trials employing standardized outcome measures are necessary to definitively establish the efficacy, compliance, and quality of life benefits of TENS for OSA treatment.