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Ansa cervicalis stimulation effects on upper airway patency: a structure-based analysis.

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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.

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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.