Clinical trial NCT06317701: Metabolic Endpoints for Obstructive Sleep Apnea Following Twelfth Cranial Nerve Stimulation
Official title: Hgns: Metabolic Endpoints For Obstructive Sleep Apnea Following Twelfth Cranial Nerve Stimulation
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Obstructive Sleep Apnea
Lead sponsor: University of Chicago
Sponsor class: OTHER
First posted: 2024-03-19
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The subjects will be recruited from the Sleep Surgery Clinic of the Duchossois Center for Advanced Medicine (DCAM) in Hyde Park and Sleep Surgery Clinic of UChicago Medicine - Orland Park. We will take advantage of the electronic medical records (EMR) to identify potential candidates using databases (EPIC-based) from the University of Chicago and Ingalls. Participants will be identified by an initial screening of patients scheduled in EPIC for drug induced sleep endoscopy (DISE).

Brief summary: The purpose of this study is to determine if the treatment of Obstructive sleep apnea (OSA) by hypoglossal nerve stimulation (HGNS) will alter glucose metabolism. The study team will also determine if the treatment of Obstructive sleep apnea (OSA) by (hypoglossal nerve stimulation) HGNS will alter predictors of cardiovascular outcomes.

Detailed description: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder in the general population. It is estimated that 80 percent of those who have OSA remain undiagnosed, and thus do not receive therapy. Strong evidence from epidemiologic and clinical studies suggests that untreated OSA is an independent risk factor for cardiometabolic disease, particularly among those with moderate-to-severe OSA. Animal and human models have revealed that intermittent hypoxia and sleep fragmentation (i.e., main features of OSA) result in insulin resistance, glucose intolerance and pancreatic beta-cell dysfunction, hypertension and dyslipidemia. Continuous positive airway pressure (CPAP) is the established first-line treatment for OSA. However, only 50% of patients with OSA are adherent to CPAP therapy. Notably, a key limitation of prior CPAP trials on cardiometabolic outcomes is low treatment adherence.

A randomized controlled trial conducted at the University of Chicago demonstrated that 8 hours of nightly CPAP reduces glucose response during oral glucose tolerance testing and improves insulin sensitivity in individuals with OSA and prediabetes. In 2014, following the pivotal Safe and Timely Antithrombotic Removal - Ticagrelor trial (STAR), the Food and Drug Administration (FDA) approved hypoglossal nerve stimulation (HNS) as an alternative therapy for OSA. Five-year outcomes from STAR have confirmed durable efficacy, tolerance, and safety for HNS. From improved tolerance and adherence, it is theorized that HNS may be more effective than CPAP at ameliorating cardiovascular and diabetes risk. Yet, there is no literature on the cardiometabolic outcomes of treating OSA with HNS.

The study team's long-term goal is to understand the metabolic and cardiovascular effects of OSA and how current therapies can mitigate risk and improve outcomes. The overall objective of this study is to determine the cardiometabolic impact of HNS therapy in patients with moderate-to-severe OSA who are intolerant to CPAP. It is hypothesized by the investigator that effective HNS treatment will improve glucose metabolism and markers of cardiovascular disease.

Eligibility criteria: Inclusion Criteria:

* Overweight or obese males and females BMI 25 kg/m2 to 40 kg/m2
* Age 18 years and older
* Diagnosed with obstructive sleep apnea by Apnea-Hypopnea Index \>15 events/hr using 4% oxygen desaturation criteria and \< 25% central events/hr on prior sleep testing Data can be derived from home sleep testing or in-lab polysomnogram
* Absent circumferential collapse on Drug-Induced Sleep Endoscopy (DISE)
* Not able to use positive airway pressure \>4 hours for 5 nights/week or unwilling to use positive airway pressure

Exclusion Criteria:

* Insulin-dependent Diabetes
* Inability to undergo in-lab polysomnography or home sleep testing
* Central Nervous System (CNS) disease with impairment of cognitive function (dementia) and/or muscle paresis, such as stroke
* Currently pregnant, trying to get pregnant or nursing
* age \< 18 years
* Regular and adherent CPAP use per clinical guidelines
* Current night shift or rotating shift work
* Diagnosis of another sleep disorder (e.g. periodic limb movement disorder)
* Current systemic steroid use
* Predominantly central sleep apnea or requiring oxygen or bi-level positive airway pressure or advanced positive airway pressure modalities
* Protected patient: under guardianship, curatorship or other legal protection, deprived of liberty by judicial or administrative decision, including hospitalized without consent

Primary outcomes:
measure: Glycemic variability
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-op
measure: Mean systolic BP (daytime and nocturnal)
timeFrame: 24 hrs at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-op
measure: Glycemic variability
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-op
Secondary outcomes:
measure: mean blood glucose levels
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: mean ambulatory glucose excursions
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: time blocks
timeFrame: 24-h, day, night at baseline and after HGNS implant, acclimation, and tuning
measure: Morning fasting insulin, including calculated insulin resistance (HOMA-IR)
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: Mean norepinephrine levels
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: Morning fasting blood glucose
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: Hemoglobin A1c
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: Insulin levels
timeFrame: at baseline and after HGNS implant, acclimation, and tuning
measure: c-peptide levels
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: fasting lipid profile (triglycerides)
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: heart rate indices by activity monitor
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: sympathetic activity by plasma norepinephrine
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: Morning fasting insulin of c-peptide level
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: fasting lipid profile (HDL- cholesterol)
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
measure: fasting lipid profile ( LDL-cholesterol)
timeFrame: at baseline and after HGNS implant, acclimation, and tuning at 3 month Post-Op
Other outcomes:
Locations:
city: Chicago
country: United States
facility: The University of Chicago
state: Illinois
Study officials:
affiliation: University of Chicago
name: Phillip LoSavio, MD, MS
role: PRINCIPAL_INVESTIGATOR
References: