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Review
. 2023 Jul 21:14:1202271.
doi: 10.3389/fneur.2023.1202271. eCollection 2023.

Beyond CPAP: modifying upper airway output for the treatment of OSA

Eli Gruenberg  1 , Jessica Cooper  1 , Tania Zamora  2 , Carl Stepnowsky  2 , Andrew M Vahabzadeh-Hagh  3 , Atul Malhotra  1 , Brandon Nokes  1   4
Affiliations
Review

Beyond CPAP: modifying upper airway output for the treatment of OSA

Eli Gruenberg et al. Front Neurol. .

Abstract

Obstructive Sleep Apnea (OSA) is exceedingly common but often under-treated. Continuous positive airway pressure (CPAP) has long been considered the gold standard of OSA therapy. Limitations to CPAP therapy include adherence and availability. The 2021 global CPAP shortage highlighted the need to tailor patient treatments beyond CPAP alone. Common CPAP alternative approaches include positional therapy, mandibular advancement devices, and upper airway surgery. Upper airway training consists of a variety of therapies, including exercise regimens, external neuromuscular electrical stimulation, and woodwind instruments. More invasive approaches include hypoglossal nerve stimulation devices. This review will focus on the approaches for modifying upper airway muscle behavior as a therapeutic modality in OSA.

Keywords: control of breathing; genioglossus; hypoglossal nerve; positive airway pressure; precision medicine; sleep disordered breathing.

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Conflict of interest statement

AM was funded by the NIH. He reports income from Merck and Livanova related to medical education. He is the Global PI for Osprey and receives income from Livanova for this role. ResMed provided philanthropic support for UC San Diego. He has no personal income from Signifier. BN is the Medical Director for Hypoglossal Nerve Stimulation at VA San Diego, but receives no industry funding or additional clinical funding for this role. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) External stimulation devices which have been utilized in OSA treatment. Left to right, ExciteOSA, TESLA, and Kalinix devices. (B) Implantable upper airway stimulation devices, including Genio, Inspire, and the Aura6000 device. IDE, Investigational Device Exemption. Image re-use permissions granted where applicable (51, 86, 87).
See this image and copyright information in PMC

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