From the Guidelines
The Excite device is a viable treatment option for obstructive sleep apnea (OSA), particularly for patients with moderate to severe OSA who cannot tolerate continuous positive airway pressure (CPAP) therapy, as highlighted in recent clinical trials and guidelines such as the European Respiratory Society guideline on non-CPAP therapies for OSA 1.
Key Highlights of the Excite Device
- The device has been shown to significantly reduce the apnea-hypopnea index (AHI) in responsive patients, with improvements in oxygen saturation levels and daytime sleepiness.
- The mechanism of action involves stimulating the hypoglossal nerve during sleep to move the tongue forward, preventing airway collapse that causes apnea events.
- The Excite device is implanted during an outpatient procedure under general anesthesia and is controlled by patients using a remote control before sleep.
Clinical Considerations
- Patient selection is crucial, as the Excite device is not suitable for all OSA patients, particularly those with central sleep apnea or specific anatomical issues.
- The European Respiratory Society guideline on non-CPAP therapies for OSA provides recommendations on the use of hypoglossal nerve stimulation, including the Excite device, based on a systematic review of the literature and assessment of the quality of evidence using the GRADE approach 1.
Treatment Outcomes
- Clinical trials have demonstrated good long-term compliance rates with the Excite device compared to CPAP therapy, making it an important alternative treatment option for patients with OSA.
- The device has been shown to improve quality of life and reduce symptoms of OSA, including daytime sleepiness and fatigue, as measured by validated scales such as the Epworth Sleepiness Scale.
From the Research
Excite Device for OSA Trial Highlights
- The Excite device is not directly mentioned in the provided studies, however, the studies discuss the use of oral appliances and positive airway pressure therapy for obstructive sleep apnea (OSA) treatment.
- A study published in 2020 2 found that combination therapy with CPAP and oral appliance reduces therapeutic CPAP requirements by 35%-45% and minimizes epiglottic pressure swings.
- Another study from 2013 3 compared oral appliance therapy and CPAP in patients with OSA and found that both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes, although CPAP was more effective in lowering the apnea-hypopnea index.
- A 2019 study 4 discussed the use of oral appliances in OSA treatment and found that mandibular advancement devices are efficacious in reducing the severity of OSA, but only to a lesser extent than standard therapy using CPAP.
- A 2020 study 5 discussed the treatment of OSA using positive airway pressure devices and found that CPAP, APAP, and BPAP are all reasonable therapies for patients with uncomplicated OSA.
- A pilot study from 2011 6 found that combination therapy of mandibular advancement devices and nasal CPAP was effective in normalizing respiratory disturbances of sleep apnea in selected OSA patients who are intolerant to CPAP.
Key Findings
- Combination therapy with CPAP and oral appliance may be a beneficial alternative for patients with incomplete responses to oral appliance therapy alone and those who cannot tolerate high CPAP levels 2, 6.
- Oral appliance therapy is a viable treatment alternative to CPAP in patients with mild to moderate OSA, but CPAP remains the treatment of first choice for patients with severe OSA 3.
- Mandibular advancement devices are efficacious in reducing the severity of OSA, but patient selection is crucial for successful treatment outcomes 4.