Electrical Stimulation in Obstructive Sleep Apnoea
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Electrical Stimulation in Obstructive Sleep Apnoea: the TESLA-home trial

Obstructive sleep apnoea (OSA), discussed in a previous blog by Dr Baiting He, is an increasingly prevalent disorder given the current obesity epidemic. The foresight report, the seminal piece of work looking at energy factors in obesity, state that "by 2050 the UK could be a mostly obese country". This report since encouraged a multi-factorial approach to tackling obesity and its consequences.

Obesity has a number of health consequences, but of interest to our group, it leads to increases in fat around the neck which can contribute to the upper airway occluding intermittently during sleep - we call this OSA. Other factors can also do this, such as the tongue falling backwards during sleep.

Image from mayoclinic.org

OSA is concerning in a number of ways - it leads to hypertension, stroke, heart disease (heart failure), a complex cause of diabetes, headaches, but also leads to excessive day time sleepiness which can severely impact ones quality of life, mood issues including depression, but also an increased risk of road traffic accidents.

Existing treatments

The current best treatment for moderate to severe OSA is called CPAP (continuous positive airway pressure). It's a large mask which is strapped on to the patient overnight while they sleep and blows air into their lungs to keep the airway open (imagine sticking your head out of the car window with your mouth open, and you'll get it).

Image taken from www.wikipedia.org

There are of course alternatives, which we discuss in another blog, however CPAP is the GOLD standard.

Future treatments - TESLA

As you can imagine, many patients are intolerant to CPAP, and therefore don't use it (imagine your head out of that car window for 6-8 hours overnight). This is a very important issue as it means these patients will develop the huge cardiovascular risk and the health issues we discussed earlier. At St Thomas' Hospital led by Professor Joerg Steier, we are developing a new treatment - TESLA: 'Transcutaneous Electrical Stimulation for SLeep Apnoea'.

Essentially these are small pads which attach under the chin, and through a small device send electrical shocks (like tiny pin pricks). These shocks travel through the skin to the tongue, stimulating it to stay forward, and also maintaining the tone of the upper airway.

Image courtesy of the TESLA - Home team.

Currently at St Thomas', in the Lane Fox Unit, a group of researchers (myself included) are recruiting patients who are unable to tolerate CPAP. We bring them in for an overnight sleep study, after which we lend them our new device to take home. In 6 weeks time investigating them again for any improvements in their sleep. We previously showed that this treatment could work in the sleep laboratory, and if the current trial taking the device in the community also works this could lead to huge improvements in the lives of patients suffering with obstructive sleep apnoea.

If you're interested in the scientific background and our journey with TESLA home, our team recently published an article in 'The HOOT'. The HOOT is the news bulletin of the British Sleep Society. You can read the full article here.

Thanks for reading,

Dr Culadeeban Ratneswaran

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Honorary Research Fellow, Guy's and St Thomas' NHS Foundation Trust

Co-founder - Remarxs | work review and project collaboration

Originally published 19 December 2018 , updated 09/01/2020

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