Improvements in patient-reported outcomes after neuromuscular electrical stimulation therapy for snoring and mild sleep apnea

Objectives: Neuromuscular electrical stimulation (NMES) offers alternative options to patients with Obstructive Sleep Apnea (OSA) unable to tolerate first line treatment. Randomized controlled trial data suggest efficacy of NMES treatment in improving OSA outcomes, snoring and sleepiness; however, no study to our knowledge has examined the effects on a range of daytime patient reported outcomes in a large real-world sample. Methods: This report presents clinical data from 472 patients completing NMES treatment. Bayesian linear mixed models were used to analyze pre-to-post treatment changes in mood (PHQ8), sleep disturbance (PROMIS-SD-4a), sleep related impairment (PROMIS-SRI-4a), and functioning (FOSQ), whilst controlling for key covariates. Posterior probabilities were calculated to estimate the probability of a change in symptoms (P(effect > 0)) and probability of exceeding a minimal clinically important difference (P(effect > MCID)). Results: The posterior probabilities of an improvement in scores in sleep disturbance (mean change -6.1, 94% HDI: -3.8 to -8.5) and sleep-related impairment (mean change -10.0, 94% HDI: -5.4 to -14), depression (mean change -3.5, 94% HDI: -1.7 to -5.2), at posttreatment were greatest and varied between 99.8 to 100%. Probability of change in functioning was low (60.9% chance of improvement). These effects remained when controlling for age, gender, treatment adherence, mean intensity and variance in intensity. Probabilities for MCI change for mood, sleep disturbance and sleep-related impairment were high (86-91%). Conclusions: The results from this report highlight the potential impact NMES therapy has on patient reported outcomes. These findings are in support of prior randomized placebo-controlled data and several observational cohort studies for NMES as treatment for mild OSA.