Obstructive sleep apnea (OSA) is a condition that occurs when unusual relaxation of the throat muscles during sleep leads to a periodic disruption of normal breathing. Because of its ability to negatively affect a person’s psychological well-being, the American Psychiatric Association classifies the condition as a diagnosable mental health disorder. In a study presented in June 2013 to the Associated Professional Sleep Societies, a multi-university research team concluded that a new treatment for obstructive sleep apnea, called electronic stimulation therapy, can prevent or reduce the muscle relaxation that triggers OSA-related symptoms.
Obstructive Sleep Apnea Basics
When defined as a mental health disorder, the full name of obstructive sleep apnea is obstructive sleep apnea hypopnea. This condition appears in the newest edition of the American Psychiatric Association guidebook called the Diagnostic and Statistical Manual of Mental Disorders, in a section dedicated to a group of conditions called breathing-related sleep disorders. In turn, all breathing-related sleep disorders form part of a larger category of conditions called sleep-wake disorders. Previous editions of the Diagnostic and Statistical Manual included a listing for breathing-related sleep disorders, but did not include a separate entry for obstructive sleep apnea.
When the throat muscles relax abnormally in people affected by OSA, their air passageways temporarily close and stop the flow of oxygen required to sustain breathing. Common symptoms of such an obstructed airway include prominent snoring, visible stoppages in breathing while asleep, unrestful sleep, unusual sleepiness during the daytime, headaches and/or chest pain upon awakening, high blood pressure, and an irritable or depressed mood. Some people with obstructive sleep apnea experience as many as 30 or more interruptions in their breathing during every hour of sleep. Others experience as few as five hourly breathing interruptions. Each pause in breathing can last up to 20 seconds or even longer.
OSA as a Mental Health Concern
To qualify as a mental health disorder, a case of obstructive sleep apnea must produce either excessive daytime sleepiness or nighttime insomnia. The affected individual must not have some other mental or physical problem that provides a better explanation for the presence of either insomnia or excessive sleepiness. In addition, he or she must not develop symptoms attributed to OSA as a consequence of prescribed medication use or substance use/abuse.
The standard treatments for obstructive sleep apnea are lifestyle modification, use of a mouthpiece that repositions the throat during sleeping, and use of a device called a CPAP device, which typically comes in the form of a mask that fits over the face and keeps the throat open with the help of a continuous flow of air. While CPAP therapy, in particular, is considered highly effective, many people fail to use their CPAP masks on a regular basis, and therefore don’t receive the proper benefits of the treatment.
Effectiveness of Electronic Stimulation Therapy
In the report presented to the Associated Professional Sleep Societies, a team of researchers from the University of Pittsburgh and Case Western Reserve University assessed the results of a study called the Stimulation Therapy for Apnea Reduction (STAR) Trial. This study examined the effectiveness of a surgical procedure for obstructive sleep apnea, called electronic stimulation therapy, which uses an implanted device to deliver small, controllable amounts of electricity to the tongue’s primary nerve. This electronic stimulation is designed to keep the throat muscles taut during sleep and prevent the breathing obstruction that leads to the onset of OSA.
During the STAR Trial, the researchers used a specific form of electronic stimulation therapy, known as Inspire Upper Airway Stimulation, on a group of 126 individuals previously diagnosed with obstructive sleep apnea. After one year of treatment, these patients experienced significant improvements in the quality of their nightly sleep. They also showed clear improvement in two different testing procedures that doctors use to rate the intensity of the apnea symptoms present in any given person.
The authors of the report believe that electronic stimulation therapy presents an effective, generally safe remedy for obstructive sleep apnea symptoms in people who don’t respond well to other treatments or fail to use their CPAP devices as prescribed. They also believe that electronic stimulation therapy is an advance over other surgical procedures for OSA that require extensive modification of the structures in a patient’s throat or face. Currently, electronic stimulation therapy is not approved as an obstructive sleep apnea treatment by the U.S. Food and Drug Administration. This approval is required before doctors can use the procedure on the general public.