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Ansa cervicalis stimulation effects on upper airway patency: a structure-based analysis
Yike Li1, Alan R Schwartz1,2,3, David Zealear1
1Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
The European Respiratory Journal
|October 14, 2024
Summary
Ansa cervicalis stimulation (ACS) reduces airway collapsibility in obstructive sleep apnoea (OSA) patients. This neurostimulation therapy effectively decreased critical closing and opening pressures across various pharyngeal structures.
Area of Science:
- Sleep Medicine
- Otolaryngology
- Biomedical Engineering
Background:
- Obstructive sleep apnoea (OSA) is a common disorder characterized by pharyngeal collapse during sleep.
- Ansa cervicalis stimulation (ACS) is a potential neurostimulation therapy for OSA, aiming to stabilize the pharynx.
- The precise impact of ACS on different sites of pharyngeal collapse (palatal, lateral wall, tongue base, epiglottis) requires detailed quantification.
Purpose of the Study:
- To quantitatively assess the effect of bilateral ACS on the collapsibility of distinct pharyngeal flow-limiting segments.
- To determine how ACS influences critical closing pressure (P_CRIT) and critical opening pressure (P_OPEN) in OSA patients.
Main Methods:
- Bilateral ACS was applied to OSA participants during drug-induced sleep endoscopy.
- Inspiratory airflow and pharyngeal collapsibility were measured across varying positive airway pressures.
- Flow-limiting structures were identified using manometric and endoscopic data.
- Linear mixed-effects models analyzed ACS effects, with univariate models exploring patient characteristic influences.
Main Results:
- Bilateral ACS significantly reduced mean P_CRIT by -3.0 cmH2O and P_OPEN by -3.7 cmH2O (p<0.001).
- Tongue base obstruction showed modeled ACS effects of -2.0 cmH2O for P_CRIT and -3.1 cmH2O for P_OPEN (p<0.001).
- Greater reductions in collapsibility were observed for palatal, oropharyngeal lateral wall, and epiglottic collapse compared to the tongue base. Lower apnea-hypopnea index correlated with greater P_OPEN reduction (p<0.01).
Conclusions:
- Bilateral ACS effectively decreases the collapsibility of all identified pharyngeal flow-limiting structures in OSA patients.
- ACS demonstrates a more pronounced effect on palatal, oropharyngeal lateral wall, and epiglottic collapse compared to tongue base collapse.
- These findings support ACS as a potential therapeutic strategy for OSA by improving airway stability through neurostimulation.
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