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A therapeutic premiere for sleep apnoea

Summary of the report

Prof. Daniel NEU, psychiatrist specialized in sleeping disorders and Dr. Grégory NAWARA, ENT, both part of the Sleep Laboratory team at the Delta Hospital are jointly conducting a case study in partnership with the CHU Brugmann Hospital on a new therapeutic approach to apnoea, partly funded by the Care Foundation. 

This case study uses the prototype of a removable oropharyngeal stent which enables an innovative mechanical splint effect by limiting retro-lingual collapse in obstructive apnoea which occurs during sleep.

This is the first publication of a scientific article where CHIREC is referenced in the international scientific journal 'The Laryngoscope'. 

 

The case study

Sleep apnoea syndrome is defined by a recurrent total or partial collapse of the upper respiratory tract during sleep.

It results in the appearance of many health risks connected with the physiopathological impact of chronic lack of oxygen in the arterial microcirculation.

These are mainly risks of cardiovascular disease, stroke, hypertension, metabolic disorders such as diabetes, as well as disorders affecting mood, concentration and libido. The fatigue caused in certain severe cases means that some patients must not be prohibited from driving a car.

The 'gold standard' in treating this apneic syndrome is a medical appliance related to a compressor, connected to the patient's nose and/or mouth through a hose.

This device is commonly known as a CPAP, the abbreviation of Continuous Positive Air Pressure. This device delivers positive pressure, like a pneumatic spring, to counter the respiratory collapse.

Although effective, 15 to 20% of patients are unable to tolerate this type of device, and the long-term follow-up also leaves something to be desired.

Many and varied surgical operations may improve apnoea, but the various multicentre studies conducted have not been able to demonstrate efficacy comparable to the CPAP. Systems using dental appliances (mandibular advancement splint) can improve the clinical picture, but remain reserved for moderate apnoea cases. 

Bearing these findings in mind, the research team (Prof. Daniel Neu, Dr Gregory Nawara, and Mr. David Bouchez), turned its attention to a new therapeutic approach.

It is deemed to offer patients a level of efficacy close to that of the CPAP, but providing comfort and discretion of use which are able to optimise compliance and observance of the treatment.

So it was that they came up with the principle of the pharyngeal stent, a tubular device, which when placed in a strategic point of the pharynx behind the tongue is capable of playing the role of a mechanical splint, in order to prevent any collapse of the upper respiratory tract.

They are currently working on a selection of a few patients in order to implement the shape, structure and positioning of the device.

Initial results are promising, and are the subject of a scientific publication in the American Journal 'Laryngoscope'. When all the data from the study has been compiled, analysed and processed, they will be able to extend the research to a larger number of patients.

The short-term aim is to be able to add this innovative type of treatment to the various therapeutic options currently available for apnoea patients.

 

References

Reference: Neu D, Nawara G, Newell J, Bouchez D and Mairesse O, First Successful Mechanical Splint for Obstructive Sleep Apnea With an Orally Administrable Pharyngeal Stenting Device. The Laryngoscope, 00:1-4, 2018. doi.org/10.1002/lary.27451.

Extract from the abstract: "The noninvasive, easily self‐administered device is mounted on a simple inferior dental guard.  Baseline total apnea‐hypopnea index (AHI) was 15.5 and 24.4 per hour of rapid eye movement (REM) sleep. With the device, total AHI dropped to 6.7 per hour (56.8% reduction) and 1.4 per hour of REM (94.3% reduction). Recorded sleep efficiency during treatment was excellent at 96.5%."