Objectives

Hypoglossal nerve stimulation is an effective treatment option for obstructive sleep apnea (OSA) in positive airway pressure therapy failure. Nonetheless, data regarding the functional effect of modifying stimulation parameters within each electrode configuration are limited.

Materials and Methods

In a retrospective study of 76 patients with 12 months or more follow-up, functional tongue protrusion thresholds were compared for pulse width and frequency configurations of 90 μsec 33 Hz vs 120 μsec 40 Hz. The number of tolerated voltage amplitude steps between sensation, functional, and subdiscomfort thresholds were assessed for both settings as well as impedances.

Results

The overall cohort showed improvement in OSA metrics: median apnea–hypopnea index from 30.0/hour to 18.6/hour and Epworth Sleepiness Scale from 13.5 to 7.6. For both bipolar and unipolar electrode configurations, the stimulation amplitude required for functional tongue protrusion was significantly reduced when the pulse width and frequency were converted from 90 μsec 33 Hz to 120 μsec 40 Hz (p < 0.001). Nevertheless, the number of voltage amplitude steps from sensation, functional, to subdiscomfort thresholds did not differ between the two settings. The ratio of automatically derived impedances between bipolar and unipolar electrode configurations was relevantly correlated with the ratio of functional thresholds at these parameters.

Conclusion

Changing the stimulation parameters may lower the voltage requirements while maintaining the same effect on tongue protrusion. Changing these stimulation parameters does not affect the range of tolerated impulse steps between functional and subdiscomfort thresholds. Future technical appliances could help estimate functional thresholds at different electrode configurations for each patient by automatically measuring impedances.

中文翻译：

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阻塞性睡眠呼吸暂停中舌下神经刺激的脉冲配置：修改脉冲宽度和频率的影响

目标

舌下神经刺激是气道正压通气治疗失败的阻塞性睡眠呼吸暂停 (OSA) 的有效治疗选择。尽管如此，关于在每个电极配置中修改刺激参数的功能效果的数据是有限的。

材料和方法

在一项对 76 名患者进行 12 个月或更长时间随访的回顾性研究中，比较了 90 微秒 33 赫兹与 120 微秒 40 赫兹的脉冲宽度和频率配置的功能性舌头突出阈值。对于两种设置和阻抗，都评估了感觉、功能和亚不适阈值之间的可容忍电压幅度步数。

结果

总体队列显示 OSA 指标有所改善：呼吸暂停-低通气指数中位数从 30.0/小时提高到 18.6/小时，Epworth 嗜睡量表从 13.5 提高到 7.6。对于双极和单极电极配置，当脉冲宽度和频率从 90 微秒 33 Hz 转换为 120 微秒 40 Hz 时，功能性舌头突出所需的刺激幅度显着降低 ( p  < 0.001)。然而，从感觉、功能到亚不适阈值的电压幅度步数在两种设置之间没有差异。双极和单极电极配置之间自动导出的阻抗的比率与这些参数的功能阈值比率相关。

结论

改变刺激参数可以降低电压要求，同时保持对舌头突出的相同效果。改变这些刺激参数不会影响功能阈值和亚不适阈值之间的可耐受脉冲步数范围。未来的技术设备可以通过自动测量阻抗来帮助估计每个患者在不同电极配置下的功能阈值。