The Effectiveness of Nasal Airway Stent Therapy for the Treatment of Mild-to-Moderate Obstructive Sleep Apnea Syndrome

Abstract

<b><i>Background:</i></b> Patients with obstructive sleep apnea syndrome (OSAS) experience excessive daytime sleepiness and insomnia and they are at risk of developing cardiovascular disease and stroke. Continuous positive airway pressure therapy could improve symptoms and decrease these risks; however, adherence is problematic. Although the oral appliance is another therapeutic option, patient satisfaction is limited and the effect of the nasal airway stent – a new device – remains unclear. <b><i>Objectives:</i></b> The aim of this study was to evaluate the effect of NAS therapy in patients with mild-to-moderate OSAS in a prospective, single-arm, interventional pilot study. <b><i>Method:</i></b> Patients with mild/moderate sleep apnea (<i>n</i> = 71; Apnea-Hypopnea Index [AHI], 5–20 events/h on polysomnography) were recruited. Sleep-associated events were measured using a portable device (WatchPAT200) pre- and immediately post-treatment and at 1 month follow-up. AHI (including supine and non-supine AHI), Oxygen Desaturation Index (ODI), Respiratory Disturbance Index (RDI), percutaneous oxygen saturation, heart rate, and snore volume were evaluated. Symptoms were assessed using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. <b><i>Results:</i></b> NAS use significantly improved AHI, supine AHI, RD, ODI, and snore volume compared to pre-intervention (<i>r</i> = 0.44, 0.48, 0.3, 0.42, and 0.34; <i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> = 0.011, <i>p</i> < 0.001, and <i>p</i> = 0.048, respectively). Additionally, 25 and 10% of patients showed complete and partial response for AHI, respectively; these improvements remained significant 1 month later. Pittsburgh Sleep Quality Index scores improved from 6.0 to 5.3 (<i>r</i> = 0.46, <i>p</i> = 0.022). <b><i>Conclusions:</i></b> NAS therapy reduced severity and snoring in patients with mild-to-moderate OSAS. Approximately 30% of patients did not tolerate NAS due to side effects.

Non-Surgical Devices for Nasal Obstruction

“…22 Ultimately 30% of patients were unable to complete the 1-month study period for Nastents in the Ohtsuka study. 15 Compliance with nasal dilators was approximately 60% at 6 months in Löth's study driven by a reported lack of benefit, poor fit, or discomfort. 23 At 5 years, compliance in the same patient population dropped to 21%.…”

“…15 Ohtsuka also studied the Nastent in patients with mild to moderate OSA and found a significant improvement in AHI (from 12.7/h to 8.6/h), Respiratory Distress Index, Oxygen Desaturation Index, and snore volume at 1month. 16 AlaxoLito devices are an alternate nasopharyngeal stenting device made from braided thin nitinol wire. A single re-useable 6-inch device is available for $974.…”

Is Continuous Positive Airway Pressure All There Is? Alternative Perioperative Treatments for Obstructive Sleep Apnea

“…Furthermore, nasopharyngeal stenting devices have been used, with some success, to address sleep-related velopharyngeal obstruction, the primary site of obstruction in the majority of OSA cases. 11 Again, this is another continuous positive airway pressure alternative that deserves further consideration.…”