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Reduced upper airway muscle activity during sleep is a key contributor to obstructive sleep apnea pathogenesis. Hypoglossal nerve stimulation activates upper airway dilator muscles, including the genioglossus, and has the potential to reduce obstructive sleep apnea severity. The objective of this study was to examine the safety, feasibility and efficacy of a novel hypoglossal nerve stimulation system (HGNS; Apnex Medical, St Paul, MN, USA) in treating obstructive sleep apnea at 12 months following implantation. Thirty-one subjects (35% female, age 52.4 ± 9.4 years) with moderate to severe obstructive sleep apnea and unable to tolerate positive airway pressure underwent surgical implantation and activation of the hypoglossal nerve stimulation system in a prospective single-arm interventional trial. Primary outcomes were changes in obstructive sleep apnea severity (apnea-hypopnea index, from in-laboratory polysomnogram) and sleep-related quality of life [Functional Outcomes of Sleep Questionnaire (FOSQ)]. Hypoglossal nerve stimulation was used on 86 ± 16% of nights for 5.4 ± 1.4 h per night. There was a significant improvement (P < 0.001) from baseline to 12 months in apnea-hypopnea index (45.4 ± 17.5 to 25.3 ± 20.6 events h(-1) ) and Functional Outcomes of Sleep Questionnaire score (14.2 ± 2.0 to 17.0 ± 2.4), as well as other polysomnogram and symptom measures. Outcomes were stable compared with 6 months following implantation. Three serious device-related adverse events occurred: an infection requiring device removal; and two stimulation lead cuff dislodgements requiring replacement. There were no significant adverse events with onset later than 6 months following implantation. Hypoglossal nerve stimulation demonstrated favourable safety, feasibility and efficacy.

Patients with a propensity for upper airway obstruction, including those with obstructive sleep apnea (OSA), are vulnerable in the perioperative period. The P SB CLOSE sb measurement method and its potential clinical utility in adults have been described.[3] However, the feasibility of obtaining perioperative measurement of P SB CLOSE sb in children under anesthesia is unknown. P SB CLOSE sb measurements were performed at two separate perioperative phases: following anesthesia induction (Pre-procedure P SB CLOSE sb ) and emergence from anesthesia (Post-procedure P SB CLOSE sb ). [Extracted from the article]

Accurate measurement of time at lights out is essential for calculation of several measures of sleep in wrist-activity monitors. While some devices use subjective reporting of time of lights out from a sleep diary, others utilise an automated proprietary scoring algorithm to calculate time at lights out, thereby negating the need for a sleep diary. This study aimed to compare sleep measures from two such devices to polysomnography (PSG) measures (In laboratory) and against each other when worn at home (At home). Fifty middle-aged adults from the Raine Study underwent overnight PSG during which they wore an ActiGraph™ and a Readiband™. They also wore both devices at home for 7 nights. The Readiband uses an automated proprietary algorithm to determine time at lights out whereas the ActiGraph requires completion of a sleep diary noting this time. In laboratory, compared to PSG: Readiband underestimated time at lights out, sleep onset, and wake after sleep onset, overestimated sleep latency and duration ( p < 0.001 for all); while ActiGraph underestimated sleep latency and wake after sleep onset and overestimated sleep efficiency and duration ( p < 0.001 for all). Similar differences between devices were observed on the laboratory night and when at home. In conclusion, an automated algorithm such as the Readiband may be used in the same capacity as the ActiGraph for the collection of sleep measures including time at sleep onset, sleep duration and time at wake. However, Readiband and ActiGraph measures of sleep latency, efficiency and wake after sleep onset should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background and Aim: Hypoglossal nerve stimulation (HNS) decreases obstructive sleep apnoea (OSA) severity via genioglossus muscle activation and decreased upper airway collapsibility. This study assessed the safety and effectiveness at 6 months post-implantation of a novel device delivering bilateral HNS via a small implanted electrode activated by a unit worn externally, to treat OSA: the Genio™ system., Methods: This prospective, open-label, non-randomised, single-arm treatment study was conducted at eight centres in three countries (Australia, France and the UK). Primary outcomes were incidence of device-related serious adverse events and change in the apnoea-hypopnoea index (AHI). The secondary outcome was the change in the 4% oxygen desaturation index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring and device use. This trial was registered with ClinicalTrials.gov, number NCT03048604., Results: 22 out of 27 implanted participants (63% male, aged 55.9±12.0 years, body mass index (BMI) 27.4±3.0 kg·m -2 ) completed the protocol. At 6 months BMI was unchanged (p=0.85); AHI decreased from 23.7±12.2 to 12.9±10.1 events·h -1 , a mean change of 10.8 events·h -1 (p<0.001); and ODI decreased from 19.1±11.2 to 9.8±6.9 events·h -1 , a mean change of 9.3 events·h -1 (p<0.001). Daytime sleepiness (Epworth Sleepiness Scale; p=0.01) and sleep-related quality of life (Functional Outcomes of Sleep Questionnaire-10; p=0.02) both improved significantly. The number of bed partners reporting loud, very intense snoring, or leaving the bedroom due to participant snoring decreased from 96% to 35%. 91% of participants reported device use >5 days per week, and 77% reported use for >5 h per night. No device-related serious adverse events occurred during the 6-month post-implantation period., Conclusions: Bilateral HNS using the Genio™ system reduces OSA severity and improves quality of life without device-related complications. The results are comparable with previously published HNS systems despite minimal implanted components and a simple stimulation algorithm., Competing Interests: Conflict of interest: P.R. Eastwood reports support for undertaking trials from Nyxoah SA, during the conduct of the study; support for undertaking trials from Oventus Pty Ltd and Zelda Therapeutics, outside the submitted work. Conflict of interest: M. Barnes has nothing to disclose. Conflict of interest: S.G. MacKay reports grants from NHMRC and Garnett-Passe RWF (conjoint grant), outside the submitted work. Conflict of interest: J.R. Wheatley reports grants from Nyxoah, during the conduct of the study. Conflict of interest: D.R. Hillman reports support for undertaking trials from Nyxoah SA, during the conduct of the study; support for undertaking trials from Oventus Pty Ltd and Zelda Therapeutics, outside the submitted work. Conflict of interest: X-L. Nguyên reports grants from Serenity Medical Services, during the conduct of the study. Conflict of interest: R. Lewis reports personal fees from Nyxoah SA, during the conduct of the study. Conflict of interest: M.C. Campbell reports personal fees from Nyxoah, outside the submitted work. Conflict of interest: B. Pételle reports consultancy fees from Bluesom, support for meeting attendance from Nyxoah, outside the submitted work. Conflict of interest: J.H. Walsh reports support for undertaking trials from Nyxoah SA, during the conduct of the study; support for undertaking trials from Oventus Pty Ltd and Zelda Therapeutics, outside the submitted work. Conflict of interest: A.C. Jones reports personal fees from Nyxoah, during the conduct of the study. Conflict of interest: C.E. Palme reports personal fees from Nyoxah, during the conduct of the study. Conflict of interest: A. Bizon has nothing to disclose. Conflict of interest: N. Meslier has nothing to disclose. Conflict of interest: C. Bertolus has nothing to disclose. Conflict of interest: K.J. Maddison has undertaken sponsored research projects for Nyxoah Pty Ltd, during the conduct of the study; has undertaken sponsored research projects for Nyxoah Pty Ltd, Oventus Pty Ltd and Zelda Pty Ltd, and reports grants from Sir Charles Gairdner Hospital and Australian and New Zealand College of Anaesthetists, outside the submitted work. Conflict of interest: L. Laccourreye reports non-financial support from Medtronic France and Integra LifeSciences Services, outside the submitted work. Conflict of interest: G. Raux has nothing to disclose. Conflict of interest: K. Denoncin has nothing to disclose. Conflict of interest: V. Attali reports personal fees for consultancy from Nyxoah, during the conduct of the study; personal fees for lectures from Resmed, institutional fees for research from Imthera, outside the submitted work. Conflict of interest: F. Gagnadoux has nothing to disclose. Conflict of interest: S.H. Launois is an employee of Serenity Medical Services/Bioserenity, reports personal fees for lectures from Cidelec, travel and/or meeting expenses from Vitalaire, S2A Santé Asten La Poste and UCB Pharma, grants from Resmed, outside the submitted work., (Copyright ©ERS 2020.)