Clinical Study Of The Effects Of Transcutaneous Submental Electrical Stimulation On Obstructive Sleep Apnea

Objective:By observing transcutaneous submental electrical stimulation on mild,moderate and severe obstructive sleep apnea（OSA）and compare them with continuous positive airway pressure（CPAP）,it is expected to provide a noninvasive,effective,and safe treatment for OSA patients.Methods:Fifty OSA patients diagnosed with polysomnography（PSG）from October 2017 to November 2019 in our hospital were collected.They were graded as mild,moderate and severe,and differences in age and body mass index（BMI）among different groups were observed.Patients in different groups were treated with transcutaneous submental electrical stimulation+PSG and CPAP+PSG for one night respectively.The two treatments were randomly determined by using a random table.The two-night treatment interval was 3 days,and the differences of the therapeutic effects of the two treatments on mild,moderate and severe OSA were compared.After another three-day washout period,continuous transcutaneous submental electrical stimulation was performed on OSA patients for 2 weeks to understand whether the patients would be tolerant to transcutaneous electrical stimulation treatment,which would be result in a reduction in the therapeutic effects and the efficacy was evaluated after treatment.Results:1.Among the 50 OSA patients included in the study,11 patients with mild OSA,23 patients with moderate OSA,and 16 patients with severe OSA were included.Using one-way ANOVA to compare the BMI and age differences of the three groups,we found that the BMI of severe OSA group was significantly higher than that of mild OSA and moderate OSA group（P<0.05）;the BMI of moderate OSA group was higher than that of mild OSA group,but there was no significant difference between the two groups（P>0.05）;The age of the severe OSA group was greater than that of the mild and moderate groups,but there was no statistically significant difference in age between the three groups（P>0.05）.2.Eleven patients with mild OSA were randomly treated with transcutaneous submental electrical stimulation+PSG and CPAP treatment+PSG,the interval between two nights was 3 days.It was found that compared with pre-treatment,transcutaneous electrical stimulation and CPAP all can significantly improve the apnea hypopnea index（AHI）,the lowest pulse oxygen saturation（LSp O₂）,the mean pulse oxygen saturation（MSp O₂）,and the differences were statistically significant（P<0.05）.Transcutaneous submental electrical stimulation did not improve the AHI and LSp O₂ of mild OSA patients as well as CPAP（P<0.05）,and there was no difference between the two treatments for improving MSp O₂（P>0.05）.3.Twenty-three patients with moderate OSA were randomly treated with transcutaneous submental electrical stimulation+PSG and CPAP treatment+PSG,the interval between two nights was 3 days.It was found that compared with pre-treatment,transcutaneous electrical stimulation and CPAP all can significantly improve AHI,LSp O₂,MSp O₂,and the differences were statistically significant（P<0.05）.Transcutaneous electrical stimulation did not improve AHI,LSp O₂,and MSp O₂ as much as CPAP（P<0.05）.4.Sixteen patients with severe OSA were randomly treated with transcutaneous submental electrical stimulation+PSG and CPAP+PSG,and the interval between two nights was 3 days.It was found that compared with pre-treatment,both transcutaneous electrical stimulation and CPAP could significantly improve AHI,LSp O₂,MSp O₂,the differences were statistically significant（P<0.05）.The improvement effects of transcutaneous electrical stimulation on AHI,LSp O₂,MSp O₂ was not as good as that of CPAP（P<0.05）,and most patients with severe OSA still had moderate to severe sleep apnea and severe nocturnal hypoxemia after transcutaneous electrical stimulation treatment.5.Fifty OSA patients underwent transcutaneous electrical stimulation for 2 weeks,we found that the AHI,LSp O₂,and epworth sleepiness scale（ESS）scores were improved compared with pre-treatment（P<0.05）,the sleep proportion of（N1+N2）decreased significantly compared with pre-treatment（P<0.05）,the proportion of N3（deep sleep）increased compared with pre-treatment（P<0.05）,the proportion of rapid eye movement（REM）was not statistically different from pre-treatment（P>0.05）.Compared with the effects of the first transcutaneous electric stimulation,AHI decreased and LSp O₂ increased after 2 weeks of continuous transcutaneous electrical stimulation（P<0.05）.Fifty OSA patients underwent transcutaneous electrical stimulation for 2 weeks,of which 4 cases were cured,19 cases were markedly effective,22 cases were effective,and 5 cases were ineffective.The total effective rate was 90%,and all patients had no significant side effects after transcutaneous electrical stimulation.Conclusion:Compared with pre-treatment,transcutaneous submental electrical stimulation can effectively improve the AHI,LSp O₂,MSp O₂ and ESS scores of OSA patients.Although the improvement effects of initial treatment on AHI,LSp O₂,MSp O₂ were not as good as that of CPAP,but it is still a noninvasive,effective and safe treatment method for OSA patients.After 2 weeks of continuous transcutaneous electrical stimulation,the sleep structure of OSA patients improved compared with pre-treatment,and the therapeutic effects didn’t decrease due to the patient’s tolerance compared with the first time of transcutaneous electrical stimulation treatment,which deserves more attention in clinical practice.