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Original Research: SLEEP DISORDERS |

Continuous Transcutaneous Submental Electrical Stimulation in Obstructive Sleep ApneaGenioglossus Stimulation in Sleep Apnea: A Feasibility Study

Joerg Steier, MD, PhD; John Seymour, PhD; Gerrard F. Rafferty, PhD; Caroline J. Jolley, MD; Eskinder Solomon, MSc; Yuanming Luo, PhD; William D.-C. Man, PhD; Michael I. Polkey, PhD; John Moxham, MD
Author and Funding Information

From the King’s College London School of Medicine, King’s Health Partners (Drs Steier, Seymour, Rafferty, Jolley, and Moxham), London, England; the King’s College Hospital (Mr Solomon), London, England; The State Key Laboratory of Respiratory Disease (Dr Luo), Guangzhou Medical School, Guangzhou, China; and the NIHR Respiratory Biomedical Research Unit (Drs Man and Polkey), Royal Brompton Hospital and Imperial College, London, England.

Correspondence to: Joerg Steier, MD, PhD, King’s College London School of Medicine, Chest Unit, 2nd Floor Cheyne Wing, Denmark Hill, London, SE5 9RS, England; e-mail: joerg.steier@kcl.ac.uk


Funding/Support: This study was funded by a HEPTAGON scheme grant from the Lord Mayor, London, England (MABZAAR).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):998-1007. doi:10.1378/chest.10-2614
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Background:  The therapeutic value of transcutaneous electrical stimulation of the genioglossus muscle in patients with obstructive sleep apnea (OSA) to reduce sleep-disordered breathing is unclear.

Methods:  Contraction of the genioglossus muscles during transcutaneous stimulation was investigated using ultrasonography in 11 healthy subjects (seven men, mean [SD] age 30 [6] years; BMI, 24.2 [3.5] kg/m2). Esophageal and gastric pressures were measured with balloon catheters, and transesophageal diaphragm electromyogram (EMGdi) was recorded during polysomnography in 11 patients with OSA (eight men, aged 51 [16] years; BMI, 42.0 [9.7] kg/m2) while transcutaneous electrical stimulation of the genioglossus was applied in non-rapid eye movement sleep (stage N2).

Results:  Ultrasonography measurements showed a significant increase in tongue diameter during stimulation (sagittal: 10.0% [2.8%]; coronal: 9.4 % [3.7%]). The measurements were reproducible and repeatable. In patients with OSA, snoring decreased during stimulation (P < .001) and oxygenation improved (P = .001); the respiratory disturbance index (RDI) fell from 28.1 (26.3) to 10.2 (10.2) events per hour during stimulation (P = .002), returning to 26.6 (26.0) events per hour after stimulation was stopped. Transdiaphragmatic pressure swing decreased from 24.1 (13.5) cm H2O to 19.7 (7.1) cm H2O (P = .022), increasing to 24.2 (10.8) cm H2O afterward, and EMGdi fell from 23.8% max (12.6% max) to 15.7% max (6.4% max) (P < .001), rising to 22.6% max (10.4% max) post stimulation.

Conclusions:  Continuous transcutaneous electrical stimulation of the genioglossus contracts the genioglossus muscle and reduces ventilatory load and neural respiratory drive in patients with OSA.

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