Transcutaneous electric stimulation: an alternative to CPAP

Introduction: Upper airway collapse during sleep is produced by a decrease of neuromuscular tone of the dilator muscles that can be increased by transcutaneous electric stimulation (TES). Many patients do not tolerate CPAP so an alternative is required. Objective: Evaluate the feasibility of TES in OSAHS patients but with no tolerance to CPAP. Material and Methods: 10 patients (8 males), 63 (51-72) years old with OSAHS and at least an AHI>30 and Epworth score >8. They had prescribed CPAP in the last 6 months but they rejected. TES of upper airway dilators muscles was performed by two transcutaneous electrodes placed under the chin area kept in position by chin straps. TES parameters were established during induced sleep apnea performed in our lab using midazolam sedation BIS < 70. Apneas and hypoapneas were assessed by nasal capnography and TES was adjusted until they disappear. They used TES at home during one week, then a home polygraphy was performed. They were asked about tolerance (good/middle/bad), if they will continue (yes/no), the Epworth score and side effects. Results: Initial data were AHI 44(8) ODI 38(8) CT90% 8% (4) snore index 44(5) and Epworth 14(5). After one week with TES: AHI 15(4) (mean difference 29(9), p<0.05), ODI 15(5) (mean diff 26(9); p<0.001), CT90% 2% (1%) (mean diff 6(5); p<0.05). All 10 patients completed a week using TES during 6 hours. Tolerance was good in 4 cases, middle in 5 and bad in 1. 9 of them thought they will continue. Epworth was 7. They referred little paresthesias as tickling, pricks and uncomfortable with chin strap. Snoring index 17(4). Conclusions: TES is a feasible alternative for OSAHS treatment that significantly reduces AHI and ODI with small side effects.