Transoral neuromuscular electrical stimulation therapy adherence and intensity levels in veterans with mild OSA

To describe the use of transoral neuromuscular stimulation therapy in Veterans with mild obstructive sleep apnea (OSA) by looking at session-level data for both adherence and stimulation intensity.

A retrospective review of session-level data of the 82 patients prescribed the eXciteOSA device at the VA San Diego Healthcare System was analyzed. The device is prescribed for use over two phases: (1) Phase 1: one daily 20-min session daily for 42 days, and (2) Phase 2: one daily 20-min session on 2 days per week.

Forty-one out of 76 patients (54 per cent) completed Phase 1 (42 sessions) within the first 60 days of using eXciteOSA therapy. Three (4 per cent) completed Phase 1 after the first 60 days, and 32 (42 per cent) patients never completed Phase 1. Initial Phase 1 graduates had a cumulative usage of 866 min, while those that did not complete Phase 1 had 578 min. Average stimulation intensity levels (SIL) in the initial Phase 1 graduates increased from week 1 to week 6 (from 3.2 to 11.2).

Based on the prescription-based adherence definition, adherence is modest but is contingent on how adherence is defined. Notably however, median positive airway pressure adherence is 40 per cent for those with a recent prescription within our facility for comparison. Future research should focus on interventions to help improve both adherence and SIL of this novel daytime OSA therapy.