Estimulación del nervio hipogloso: una nueva alternativa en el tratamiento de la apnea obstructiva del sueño
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mar 22, 2014
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Resumen
Introducción: la apnea obstructiva del sueño (AOS) es el trastorno respiratorio del sueño más frecuente. La terapia de elección es la presión positiva continua de la vía aérea (CPAP), pero se ha descrito mala adherencia en su uso. La estimulación del nervio hipogloso (ENH) se encuentra entre las nuevas modalidades de tratamiento en estudio.
Objetivo: revisar la fisiopatología de este trastorno, así como la efectividad y seguridad de la ENH como terapia de la AOS.
Metodología: se realizó una búsqueda en la base de datos de Medline utilizando las palabras clave: Sleep Apnea, Syndrome; Sleep Apnea, Obstructive; Hypoglossal Nerve; Electrodes, Implanted; Implantable Neurostimulators, y Electric Stimulation Therapy.
Resultados: se encontraron 267 artículos, de los cuales se seleccionaron 27 según los criterios de inclusión y exclusión. Adicionalmente, se hizo una búsqueda secundaria de estos artículos. La ENH ha mostrado un perfil de efectividad y seguridad favorable con alta adherencia como tratamiento de la AOS. Sin embargo, no se recomienda en pacientes con un índice apnea-hipopnea > 50, ya que produce una reducción parcial, inferior que la que puede producir el CPAP.
Conclusiones: la ENH ayuda a corregir, parcialmente, uno de los mecanismos fisiopatológicos de la AOS. Si bien en la revisión se encontraron datos que sugieren efectividad y seguridad aceptables en corto plazo, se necesitan más estudios sobre efectividad y seguridad a largo plazo, sobre comparación directa con CPAP en algunos casos y sobre uso bilateral de esta nueva modalidad terapéutica.
Keywords
apnea del sueño obstructiva, nervio hipogloso, terapia por estimulación eléctrica, Sleep apnea, obstructive, hypoglossal nerve, electric stimulation therapy,
References
1. Farré R, Montserrat J, Navajas D. Assessment
of upper airway mechanics
during sleep. Respir Physiol Neurobiol.
2008;163(1-3):74-81.
2. Akinnusi M, Saliba R, El-Solh A. Emerging
therapies for obstructive sleep apnea.
Lung. 2012;190(4):365-71.
3. Eastwood P, Barnes M, Walsh J et al.
Treating obstructive sleep apnea with
hypoglossal nerve stimulation. Sleep.
2011;34(11):1479-86.
4. Verbraecken J, De backer W. Upper airway
mechanics. Respiration. 2009;78(2):
121-33.
5. Remmers J, deGroot W, Sauerland E,
Anch A. Pathogenesis of upper airway
occlusion during sleep. J Appl Physiol.
1978;44:931-8.
6. Gastaut H, Tassinari C, Duron B. Polygraphic
study of diurnal and nocturnal
(hypnic and respiratory) episodal manifestations
of Pickwick syndrome. Rev
Neurol (Paris). 1965;112:568-79.
7. Ryan C, Bradley T. Pathogenesis of obstructive
sleep apnea. J Appl Physiol.
2005;99(6):2440-50.
8. Dubois A. Airway resistance. Am J
Respir Crit Care Med. 2000;162(2 Pt
1):345-6.
9. Schwartz A, Bennett M, Smith P et al.
Therapeutic electrical stimulation of the
hypoglossal nerve in obstructive sleep
apnea. Arch Otolaryngol Head Neck
Surg. 2001;127(10):1216-23.
10. Georgalas C. The role of the nose in
snoring and obstructive sleep apnoea:
an update. Eur Arch Otorhinolaryngol.
2011;268(9):1365-73.
11. Rowley J, Permutt S, Willey S et al. Effect of tracheal and tongue displacement on upper airway airflow dynamics. J Appl Physiol. 1996;80:2171-8.
12. Dempsey J, Veasey S, Morgan B, O‘Donnell C. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112.
13. Oliven A, O‘Hearn D, Boudewyns A et al. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea. J Appl Physiol. 2003;95(5):2023-9.
14. Oliven A. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Curr Opin Pulm Med. 2011;17(6):419-24.
15. Kribbs N, Pack A, Kline L et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993; 147(4):887-95.
16. Kezirian E, Boudewyns A, Eisele D et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Med Rev. 2010;5:299-305.
17. Pierce R, Worsnop C. Upper airway function and dysfunction in respiration. Clin Exp Pharmacol Physiol. 1999;26(1):1-10.
18. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg. 2002;109(3):1128-46.
19. Kaminsky DA. What does airway resistance tell us about lung function? Respir Care. 2012;57(1):85-96.
20. Sériès F. Upper airway muscles awake and asleep. Sleep Med Rev. 2002;6(3):229-42.
21. Cosío B, Rodríguez Rosado J. [Importance of the distal airway in COPD]. Arch Bronconeumol. 2011;47 Suppl 2:32-7.
22. White D. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172:1363-70.
23. Eckert D, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:144-53.
24. Eisele D, Schwartz A, Hari A et al. The effects of selective nerve stimulation on upper airway airflow mechanics. Arch Otolaryngol Head Neck Surg. 1995;121:1361-4.
25. Bishara H, Odeh M, Schnall R et al. Electrically-activated dilator muscles reduce pharyngeal resistance in anaesthetized dogs with upper airway obstruction. Eur Respir J. 1995;8:1537-42.
26. Dotan Y, Golibroda T, Oliven R et al. Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea. Eur Respir J. 2011;38:338-47.
27. Oliven A, Schnall R, Odeh M. Improved upper airway patency elicited by electrical stimulation of the hypoglossus nerves. Respiration. 1996;63:213-6.
28. Schwartz A, Thut D, Russ B et al. Effect of electrical stimulation of the hypoglossal nerve on airflow mechanics in the isolated upper airway. Am Rev Respir Dis. 1993;147:1144-50.
29. Kuna ST. Regional effects of selective pharyngeal muscle activation on airway shape. Am J Respir Crit Care Med. 2004;169(9):1063-9.
30. Bellemare F, Pecchiari M, Bandini M et al. Reversibility of airflow obstruction by hypoglossus nerve stimulation in anesthetized rabbits. Am J Respir Crit Care Med. 2005;172:606-12.
31. Fregosi R. Influence of tongue muscle contraction and dynamic airway pressure on velopharyngeal volume in the rat. J Appl Physiol. 2008;104:682-93.
32. Yoo P, Durand D. Effects of selective hypoglossal nerve stimulation on canine upper airway mechanics. J Appl Physiol. 2005;99:937-43.
33. Goding G, Eisele D, Testerman R et al. Relief of upper airway obstruction with hypoglossal nerve stimulation in the canine. Laryngoscope. 1998;108:162-9.
34. Miki H, Hida W, Inoue H et al. A new treatment for obstructive sleep apnea syndrome by electrical stimulation of submental region. Tohoku J Exp Med. 1988;154(1):91-2.
35. Hida W, Okabe S, Miki H et al. Effects of submental stimulation for several consecutive nights in patients with obstructive sleep apnoea. Thorax. 1994;49(5):446-52.
36. Isono S, Tanaka A, Nishino T. Effects of tongue electrical stimulation on pharyngeal mechanics in anaesthetized patients with obstructive sleep apnoea. Eur Respir J. 1999;14(6):1258-65.
37. Huang J, Sahin M, Durand DM. Dilation of the oropharynx via selective stimulation of the hypoglossal nerve. J Neural Eng. 2005;2(4):73-80.
38. Oliven A, O‘Hearn D, Boudewyns A et al. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea. J Appl Physiol. 2003;95(5):2023-9.
39. Oliven A, Tov N, Geitini L, Steinfeld U, Oliven R, Schwartz A. Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J. 2007;30:748-58.
40. Randerath WJ, Galetke W, Domanski U et al. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004;27(2):254-9.
41. Decker M, Haaga J, Arnlod JL et al. Functional electrical stimulation and respiration during sleep. J Appl Physiol. 1993;75:1053-61.
42. Miki H, Hida W, Chonan T et al. Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea. Am Rev Respir Dis. 1989;140:1285-9.
43. Schwartz A, Eisele DW, Hari A et al. Electrical stimulation of the lingual musculature in obstructive sleep apnea. J Appl Physiol. 1996;81:643-52.
44. Smith P, Eisele D, Podszus T et al. Electrical stimulation of upper airway musculature. Sleep 1996;19(10):S284-7.
45. Oliven A, Tov N, Geitini L et al. Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J. 2007;30(4):748-58.
46. Oliven R, Tov N, Odeh M et al. Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea. J Appl Physiol. 2009;106(5):1668-73.
47. Oliven A, Kaufman E, Kaynan R et al. Mechanical parameters determining pharyngeal collapsibility in patients with sleep apnea. J Appl Physiol. 2010; 109: 1037-44.
48. Dotan Y, Golibroda T, Netzer A, Oliven A. Interaction between tongue movement and velopharyngeal size and stability during genioglossus stimulation in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:A2725.
49. Schwartz A, Barnes M, Hillman D et al. Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea. Am J Respir Crit Care Med. 2012;185(4):420-6.
50. Badr M, Oliven A, Maurer J. Predictor of response for upper airway stimulation in obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:A2727.
51. Mwenge G, Rombaux P, Dury M et al. Targeted hypoglossal neurostimulation for obstructive sleep apnoea: a 1-year pilot study. Eur Respir J. 2013;41(2):360-7.
52. Barbé F, Masa JF. Hypoglossal neurostimulation for obstructive sleep apnoea. Eur Respir J. 2013;41(2):257-8.
53. Rodenstein D, Rombaux P, Lengele B et al. Residual effect of THN hypoglossal stimulation in obstructive sleep apnea: a disease-modifying therapy. Am J Respir Crit Care Med. 2013;187(11):1276-8.
of upper airway mechanics
during sleep. Respir Physiol Neurobiol.
2008;163(1-3):74-81.
2. Akinnusi M, Saliba R, El-Solh A. Emerging
therapies for obstructive sleep apnea.
Lung. 2012;190(4):365-71.
3. Eastwood P, Barnes M, Walsh J et al.
Treating obstructive sleep apnea with
hypoglossal nerve stimulation. Sleep.
2011;34(11):1479-86.
4. Verbraecken J, De backer W. Upper airway
mechanics. Respiration. 2009;78(2):
121-33.
5. Remmers J, deGroot W, Sauerland E,
Anch A. Pathogenesis of upper airway
occlusion during sleep. J Appl Physiol.
1978;44:931-8.
6. Gastaut H, Tassinari C, Duron B. Polygraphic
study of diurnal and nocturnal
(hypnic and respiratory) episodal manifestations
of Pickwick syndrome. Rev
Neurol (Paris). 1965;112:568-79.
7. Ryan C, Bradley T. Pathogenesis of obstructive
sleep apnea. J Appl Physiol.
2005;99(6):2440-50.
8. Dubois A. Airway resistance. Am J
Respir Crit Care Med. 2000;162(2 Pt
1):345-6.
9. Schwartz A, Bennett M, Smith P et al.
Therapeutic electrical stimulation of the
hypoglossal nerve in obstructive sleep
apnea. Arch Otolaryngol Head Neck
Surg. 2001;127(10):1216-23.
10. Georgalas C. The role of the nose in
snoring and obstructive sleep apnoea:
an update. Eur Arch Otorhinolaryngol.
2011;268(9):1365-73.
11. Rowley J, Permutt S, Willey S et al. Effect of tracheal and tongue displacement on upper airway airflow dynamics. J Appl Physiol. 1996;80:2171-8.
12. Dempsey J, Veasey S, Morgan B, O‘Donnell C. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112.
13. Oliven A, O‘Hearn D, Boudewyns A et al. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea. J Appl Physiol. 2003;95(5):2023-9.
14. Oliven A. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Curr Opin Pulm Med. 2011;17(6):419-24.
15. Kribbs N, Pack A, Kline L et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993; 147(4):887-95.
16. Kezirian E, Boudewyns A, Eisele D et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Med Rev. 2010;5:299-305.
17. Pierce R, Worsnop C. Upper airway function and dysfunction in respiration. Clin Exp Pharmacol Physiol. 1999;26(1):1-10.
18. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg. 2002;109(3):1128-46.
19. Kaminsky DA. What does airway resistance tell us about lung function? Respir Care. 2012;57(1):85-96.
20. Sériès F. Upper airway muscles awake and asleep. Sleep Med Rev. 2002;6(3):229-42.
21. Cosío B, Rodríguez Rosado J. [Importance of the distal airway in COPD]. Arch Bronconeumol. 2011;47 Suppl 2:32-7.
22. White D. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172:1363-70.
23. Eckert D, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:144-53.
24. Eisele D, Schwartz A, Hari A et al. The effects of selective nerve stimulation on upper airway airflow mechanics. Arch Otolaryngol Head Neck Surg. 1995;121:1361-4.
25. Bishara H, Odeh M, Schnall R et al. Electrically-activated dilator muscles reduce pharyngeal resistance in anaesthetized dogs with upper airway obstruction. Eur Respir J. 1995;8:1537-42.
26. Dotan Y, Golibroda T, Oliven R et al. Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea. Eur Respir J. 2011;38:338-47.
27. Oliven A, Schnall R, Odeh M. Improved upper airway patency elicited by electrical stimulation of the hypoglossus nerves. Respiration. 1996;63:213-6.
28. Schwartz A, Thut D, Russ B et al. Effect of electrical stimulation of the hypoglossal nerve on airflow mechanics in the isolated upper airway. Am Rev Respir Dis. 1993;147:1144-50.
29. Kuna ST. Regional effects of selective pharyngeal muscle activation on airway shape. Am J Respir Crit Care Med. 2004;169(9):1063-9.
30. Bellemare F, Pecchiari M, Bandini M et al. Reversibility of airflow obstruction by hypoglossus nerve stimulation in anesthetized rabbits. Am J Respir Crit Care Med. 2005;172:606-12.
31. Fregosi R. Influence of tongue muscle contraction and dynamic airway pressure on velopharyngeal volume in the rat. J Appl Physiol. 2008;104:682-93.
32. Yoo P, Durand D. Effects of selective hypoglossal nerve stimulation on canine upper airway mechanics. J Appl Physiol. 2005;99:937-43.
33. Goding G, Eisele D, Testerman R et al. Relief of upper airway obstruction with hypoglossal nerve stimulation in the canine. Laryngoscope. 1998;108:162-9.
34. Miki H, Hida W, Inoue H et al. A new treatment for obstructive sleep apnea syndrome by electrical stimulation of submental region. Tohoku J Exp Med. 1988;154(1):91-2.
35. Hida W, Okabe S, Miki H et al. Effects of submental stimulation for several consecutive nights in patients with obstructive sleep apnoea. Thorax. 1994;49(5):446-52.
36. Isono S, Tanaka A, Nishino T. Effects of tongue electrical stimulation on pharyngeal mechanics in anaesthetized patients with obstructive sleep apnoea. Eur Respir J. 1999;14(6):1258-65.
37. Huang J, Sahin M, Durand DM. Dilation of the oropharynx via selective stimulation of the hypoglossal nerve. J Neural Eng. 2005;2(4):73-80.
38. Oliven A, O‘Hearn D, Boudewyns A et al. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea. J Appl Physiol. 2003;95(5):2023-9.
39. Oliven A, Tov N, Geitini L, Steinfeld U, Oliven R, Schwartz A. Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J. 2007;30:748-58.
40. Randerath WJ, Galetke W, Domanski U et al. Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea. Sleep. 2004;27(2):254-9.
41. Decker M, Haaga J, Arnlod JL et al. Functional electrical stimulation and respiration during sleep. J Appl Physiol. 1993;75:1053-61.
42. Miki H, Hida W, Chonan T et al. Effects of submental electrical stimulation during sleep on upper airway patency in patients with obstructive sleep apnea. Am Rev Respir Dis. 1989;140:1285-9.
43. Schwartz A, Eisele DW, Hari A et al. Electrical stimulation of the lingual musculature in obstructive sleep apnea. J Appl Physiol. 1996;81:643-52.
44. Smith P, Eisele D, Podszus T et al. Electrical stimulation of upper airway musculature. Sleep 1996;19(10):S284-7.
45. Oliven A, Tov N, Geitini L et al. Effect of genioglossus contraction on pharyngeal lumen and airflow in sleep apnoea patients. Eur Respir J. 2007;30(4):748-58.
46. Oliven R, Tov N, Odeh M et al. Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea. J Appl Physiol. 2009;106(5):1668-73.
47. Oliven A, Kaufman E, Kaynan R et al. Mechanical parameters determining pharyngeal collapsibility in patients with sleep apnea. J Appl Physiol. 2010; 109: 1037-44.
48. Dotan Y, Golibroda T, Netzer A, Oliven A. Interaction between tongue movement and velopharyngeal size and stability during genioglossus stimulation in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:A2725.
49. Schwartz A, Barnes M, Hillman D et al. Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea. Am J Respir Crit Care Med. 2012;185(4):420-6.
50. Badr M, Oliven A, Maurer J. Predictor of response for upper airway stimulation in obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:A2727.
51. Mwenge G, Rombaux P, Dury M et al. Targeted hypoglossal neurostimulation for obstructive sleep apnoea: a 1-year pilot study. Eur Respir J. 2013;41(2):360-7.
52. Barbé F, Masa JF. Hypoglossal neurostimulation for obstructive sleep apnoea. Eur Respir J. 2013;41(2):257-8.
53. Rodenstein D, Rombaux P, Lengele B et al. Residual effect of THN hypoglossal stimulation in obstructive sleep apnea: a disease-modifying therapy. Am J Respir Crit Care Med. 2013;187(11):1276-8.
Cómo citar
Pérez García, I. C., Salcedo Betancourt, J. D., Ríos Rosado, E. C., Ruiz Morales, Álvaro J., Ospina García, J. C., & Hidalgo Martínez, P. (2014). Estimulación del nervio hipogloso: una nueva alternativa en el tratamiento de la apnea obstructiva del sueño. Universitas Medica, 55(3), 286–296. https://doi.org/10.11144/Javeriana.umed55-3.enhn
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