Abstract
The objective of the study was to investigate the first-night treatment success of a nasopharyngeal stent compared to standard nCPAP-titration. This is a case series and a single-center study. Eight participants (n = 8) were selected with untreated obstructive sleep apnea with a prestudy AHI ≥10. A newly developed nasopharyngeal stent was tested individually versus standard nCPAP-titration. Cardiorespiratory polysomnography was performed on two consecutive nights (random order: stent, nCPAP). The AHI, the number of obstructive apneas and hypopneas, the mean oxygen saturation, and the minimum oxygen saturation were compared before and after using the nasopharyngeal stent or standard nCPAP. The AHI value before treatment (AHIpre) was 31.1 ± 12.0 (mean ± standard deviation). After inserting the AlaxoStent, the mean AHIstent was 19 ± 12.0 compared to mean AHInCPAP 8.2 ± 11.9 with standard nCPAP-titration. Both nasopharyngeal stenting and nCPAP-titration could reduce the mean number of obstructive apneas by >94 %. Compared to responder rates of classic surgical interventions like uvulopalatopharyngoplasty or multi-level surgery, the nasopharyngeal stent seems to give a comparable responder rate of 50 %. There were no complications associated with the use of the stent and it was well tolerated by all subjects. Nasopharyngeal stenting widens the range of non-invasive mechanical treatment and seems to be an effective mechanical therapeutic alternative to surgery in nCPAP non-compliant patients with OSA. Careful selection of the patient population is a prerequisite of treatment and therefore it should be reserved for individual cases only.
Similar content being viewed by others
References
Doherty LS, Kiely JL, Swan V et al (2005) Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127:2076–2084
Duchna HW (2006) Sleep-related breathing disorders—a second edition of the International Classification of Sleep Disorders (ICSD-2) of the American Academy of Sleep Medicine (AASM). Pneumologie 60:568–575
Franklin KA, Anttila H, Axelsson S et al (2009) Effects and side-effects of surgery for snoring and obstructive sleep apnea—a systematic review. Sleep 32:27–36
Freuschle A, Heiser C, Maurer JT et al (2013) Treatment of obstructive sleep apnea with the AlaxoStent©. Somnologie 17:212–214
Giles TL, Lasserson TJ, Smith BH et al (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev (3):CD001106
Gold AR, Marcus CL, Dipalo F et al (2002) Upper airway collapsibility during sleep in upper airway resistance syndrome. Chest 121:1531–1540
Iber C, Ancoli-Israel S, Chesson A et al (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester
Isono S (2012) Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 17:32–42
Jordan AS, White DP (2008) Pharyngeal motor control and the pathogenesis of obstructive sleep apnea. Respir Physiol Neurobiol 160:1–7
Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med JCSM Off Pub Am Acad Sleep Med 4:157–171
Mcardle N, Devereux G, Heidarnejad H et al (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:1108–1114
Nahmias JS, Karetzky MS (1988) Treatment of the obstructive sleep apnea syndrome using a nasopharyngeal tube. Chest 94:1142–1147
Paulsen FP, Steven P, Tsokos M et al (2002) Upper airway epithelial structural changes in obstructive sleep-disordered breathing. Am J Respir Crit Care Med 166:501–509
Powell HR, Watson NA, Kotecha BT (2014) Pilot study assessing the efficacy of a novel treatment for sleep related breathing disorders in patients undergoing sleep nasendoscopy. Clin Otolaryngol Off J ENT-UK Off J Neth Soc Otorhinolaryngol Cervicofac Surg
Randerath WJ, Verbraecken J, Andreas S et al (2011) Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J Off J Eur Soc Clin Respir Physiol 37:1000–1028
Ryan CM, Bradley TD (2005) Pathogenesis of obstructive sleep apnea. J Appl Physiol 99:2440–2450
Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177
Sin DD, Mayers I, Man GC et al (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121:430–435
Sullivan CE, Issa FG (1985) Obstructive sleep apnea. Clin Chest Med 6:633–650
Verse T, De La Chaux R, Dreher A et al (2008) Guideline: treatment of adult obstructive sleep apnea. Laryngorhinootologie 87:192–204
Wozniak DR, Lasserson TJ, Smith I (2014) Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 1:CD007736
Young T, Shahar E, Nieto FJ et al (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162:893–900
Acknowledgments
Additional Study investigator: Florian Ruberg MD, Private Practice for Otorhinolaryngology, Neustadt, Germany. Data analysis: Philipp, Grundtner, Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Ethical approval
All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
The study was performed at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Germany.
Rights and permissions
About this article
Cite this article
Traxdorf, M., Hartl, M., Angerer, F. et al. A novel nasopharyngeal stent for the treatment of obstructive sleep apnea: a case series of nasopharyngeal stenting versus continuous positive airway pressure. Eur Arch Otorhinolaryngol 273, 1307–1312 (2016). https://doi.org/10.1007/s00405-015-3815-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-015-3815-2