Beyond CPAP: modifying upper airway output for the treatment of OSA

Eli Gruenberg; Jessica Cooper; Tania Zamora; Carl Stepnowsky; Andrew M Vahabzadeh-Hagh; Atul Malhotra; Brandon Nokes

doi:10.3389/fneur.2023.1202271

Beyond CPAP: modifying upper airway output for the treatment of OSA

Front Neurol. 2023 Jul 21:14:1202271. doi: 10.3389/fneur.2023.1202271. eCollection 2023.

Authors

Eli Gruenberg¹, Jessica Cooper¹, Tania Zamora², Carl Stepnowsky², Andrew M Vahabzadeh-Hagh³, Atul Malhotra¹, Brandon Nokes^{1

4}

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, CA, United States.
² Health Services Research and Development, Veteran's Affairs (VA) San Diego Healthcare System, San Diego, CA, United States.
³ Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla, CA, United States.
⁴ Sleep Section at the Veteran's Affairs (VA) San Diego Healthcare System, San Diego, CA, United States.

Abstract

Obstructive Sleep Apnea (OSA) is exceedingly common but often under-treated. Continuous positive airway pressure (CPAP) has long been considered the gold standard of OSA therapy. Limitations to CPAP therapy include adherence and availability. The 2021 global CPAP shortage highlighted the need to tailor patient treatments beyond CPAP alone. Common CPAP alternative approaches include positional therapy, mandibular advancement devices, and upper airway surgery. Upper airway training consists of a variety of therapies, including exercise regimens, external neuromuscular electrical stimulation, and woodwind instruments. More invasive approaches include hypoglossal nerve stimulation devices. This review will focus on the approaches for modifying upper airway muscle behavior as a therapeutic modality in OSA.

Keywords: control of breathing; genioglossus; hypoglossal nerve; positive airway pressure; precision medicine; sleep disordered breathing.

Publication types

Review