Intraoral Neuromuscular Stimulation Device and Rapid Eye Movement-Dependent Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep breathing disorder characterized by recurrent pharyngeal collapse secondary to the decreased tone of the pharyngeal dilator muscles. The genioglossus muscle is a major pharyngeal dilator responsible for maintaining the upper airway. Research has shown that patients with OSA have a stronger but less endurant genioglossus muscle. Research has also demonstrated that neuromuscular electrical stimulation of the skeletal muscles in the genioglossus was associated with improvement in muscular endurance and hence improvement in mild OSA. This has led to the development of a novel intraoral neuromuscular stimulation device for treating snoring and mild OSA. It is known that OSA is worse in rapid eye movement (REM) sleep compared to other stages of sleep due to neurologically mediated impairment of skeletal muscles. What has not been demonstrated so far is if the intraoral neuromuscular stimulation device improves the apnea-hypopnea index (AHI) in REM sleep. Our case report highlights the significant improvement of REM-dependent OSA in a middle-aged female with consistent use of an intraoral neuromuscular stimulation device marketed as eXciteOSA® (Signifier Medical Technologies, Needham, MA).