Who will desire upper airway stimulation as a treatment of obstructive sleep apnea in the Japanese patient population?
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EDITORIAL
Who will desire upper airway stimulation as a treatment of obstructive sleep apnea in the Japanese patient population? Takatoshi Kasai1,2,3,4,5
© Japanese Society of Sleep Research 2020
Obstructive sleep apnea (OSA) is a common chronic condition [1], observed in 10–20% of the general population [2]. Current population-based studies, including data from Japan, suggested that in addition to men, a substantial proportion of women, especially post-menopausal women, have OSA [2]. Continuous positive airway pressure (CPAP) therapy has been an established treatment option and generally considered as a first-line treatment for moderate to severe OSA. Nowadays, more than 400,000 patients in Japan with OSA are using CPAP. However, several patients with OSA underuse or even discontinue CPAP therapy, and reportedly, 29–83% were poorly adherent [3]. Although a recent big data analysis in the US found increasing adherence over time (up to 87% adherent), characteristics, the severity of OSA, and presence or absence of sleepiness are considered as important factors for CPAP adherence [3]. Another option for the treatment of OSA includes use of a mandibular advancement device (MAD). However, the efficacy of MAD on the suppression of OSA varies [4]. Although adherence to MAD use is generally considered better than that to CPAP therapy [5], adherence to MAD use is also highly variable ranging from 32 to 82% at 1 year [5]. Therefore, effective alternatives
* Takatoshi Kasai kasai‑[email protected] 1
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo 113‑8421, Japan
2
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
3
Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
4
Department of Digital Health and Telemedicine R&D, Faculty of Health Science, Juntendo University, Tokyo, Japan
5
Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
that can successfully suppress OSA and maintain adherence are needed. Upper airway stimulation (UAS) may be one such alternative for preventing upper airway collapse [6]. The concept of UAS was proposed over 30 years ago [7], but UAS via hypoglossal nerve stimulation recently came into use clinically and will be available in Japan. Hypoglossal nerve stimulation aims to provide electrical stimulation through the programmable generator implanted subcutaneously on the chest wall to activate the muscles to keep the upper airway open during sleep without wearing a nasal/oronasal mask and any other oral appliances [6]. In the US and European countries, UAS using a hypoglossal nerve stimulation device has been approved for several years, and the efficacy of UAS was prominent, especially in less obese patients. [6] As patients do not need to wear masks and oral appliances during sleep, adherence may not be an issue with UAS. Thus, UAS can be an effectiv
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