Upper airway stimulation in obstructive sleep apnea improves glucose metabolism and reduces hedonic drive for food

Abstract

Upper airway stimulation is a new and effective second‐line treatment for obstructive sleep apnea, but possible consequences on glucose metabolism and central regulation of food intake are unclear. Twenty patients were prospectively studied before and 12 months after obstructive sleep apnea treatment by upper airway stimulation. Respiratory parameters and daytime sleepiness were assessed to document effectiveness of treatment. Glucose metabolism was assessed by the oral glucose tolerance test, and hedonic versus homeostatic drive to eat was characterized. At 12 months, upper airway stimulation significantly improved measures of obstructive sleep apnea (all p < 0.01). Despite no change in body weight, fasting C‐peptide insulin resistance index (p = 0.01) as well as insulin and C‐peptide levels at 60 min during the oral glucose tolerance test (p < 0.02) were reduced. Hedonic drive to eat was strongly reduced (p < 0.05), while leptin and ghrelin remained unchanged (p > 0.15). Upper airway stimulation is effective in treatment of obstructive sleep apnea and improves glucose metabolism. Reduced hedonic drive to eat might contribute to these metabolic improvements. These promising findings are in need for long‐term controlled evaluation of metabolic sequelae of upper airway stimulation and to mechanistically evaluate the metabolic benefits of upper airway stimulation in patients with obstructive sleep apnea.

International Consensus Statement on Obstructive Sleep Apnea

“…Within the STAR cohort, Inspire responders had reduced HRV suggesting lower sympathetic tone and improved CV health 1898 . In non‐diabetic patients, HNS reduced insulin resistance and improved oral glucose tolerance 1899 . A retrospective study comparing ADHERE and a PAP cohort found HNS improved systolic and mean arterial pressures (MAPs) of baseline hypertensive patients, whereas PAP improved pressure measures in all groups, especially diastolic and MAP 1900 .…”

“…1898 In non-diabetic patients, HNS reduced insulin resistance and improved oral glucose tolerance. 1899 A retrospective study comparing ADHERE and a PAP cohort found HNS improved systolic and mean arterial pressures (MAPs) of baseline hypertensive patients, whereas PAP improved pressure measures in all groups, especially diastolic and MAP. 1900 Benefit: Improvement in objective and subjective measures of OSA.…”

A global consensus regarding the evaluation and management of sleepiness in obstructive sleep apnoea: results of a Delphi process

“…1897 In non-diabetic patients, HNS reduced insulin resistance and improved oral glucose tolerance. 1898 A retrospective study comparing ADHERE and a PAP cohort found HNS improved systolic and mean arterial pressures of baseline hypertensive patients, whereas PAP improved pressure measures in all groups, especially diastolic and mean arterial pressure.…”

Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

“…Several retrospective comparative studies show better OSA outcomes of HNS treatment compared to traditional sleep surgery [31][32][33]. First reports documented positive effects on glucose metabolism and heart frequency variability [34,35]. A recent prospective multicenter study, which show relevant improvement of OSA in HNS therapy compared with no treatment [12].…”