Neuromuscular electrical stimulation therapy and obstructive sleep apnoea hypopnoea syndrome – is it effective in the real world?

Neuromuscular electrical stimulation therapy (NMES), a novel treatment for obstructive sleep apnoea (OSA) stimulates and retrains the tongue muscle preventing collapse. The aim was to determine the objective and subjective effectiveness of NMES in OSA. OSA patients (oxygen desaturation index (ODI) <20/hour) were required to use NMES 20 minutes a day for 6 weeks (phase 1) and then 20 minutes twice a week for maintenance (phase 2). Intensity was increased to a minimum of 7 Hertz. A sleep study and Epworth sleepiness score (ESS) was repeated after 3 months of NMES. Descriptive statistics and Pearson’s correlation performed to determine the effect of NMES on ODI and ESS. 32 patients attempted NMES. 15 (47%; 5 females; 53 years±11years) completed phase 1 and 2. Adherence was 80±6% (phase 1) and 56±10% at time of sleep study, intensity level 11.8±2 Hz. Failure reasons include 13 did not attend follow up, 1 did not start treatment, 1 had increasing symptoms, 1 lost weight, 1 experienced tongue swelling and sore gums. No significant difference in ODI (p=0.082), a significant difference in ESS (p=0.032). No correlation between intensity and ODI (r=0.058) and adherence and ODI (r=-0.065), a moderate correlation between adherence and post ESS (r=0.351), and a strong correlation between intensity and post ESS (r=0.524). The ODI did not improve with NMES with over half demonstrating an increase in ODI. NMES improved sleepiness with greater intensity. Patients demonstrated a low adherence rate and consequently a low sample size was used which is likely to skew results. Reasons for low adherence and assessing the effects of NMES on a larger cohort is recommended.