1. Graph paper template R2 이지훈 / Prof. 박명재 N Engl J Med 2014;370:139-49.

2. BACKGROUND OBSTRUCTIVE SLEEP APNEA –Recurrent narrowing and closure of upper airway –Excessive sleepiness and impaired quality of life –Independent risk factor for Insulin resistance Dyslipidemia Vascular disease Death –Alternative treatments to CPAP –“Upper-airway stimulation”

4. METHODS PARTICIPANTS –Moderate-to-severe obstructive sleep apnea –Exclusion criteria BMI of more than 32.0 Neuromuscular disease Hypoglossal-nerve palsy Severe restrictive or obstructive pulmonary disease Moderate-to-severe pulmonary artery hypertension Severe valvular heart diesase NYHA class Ⅲ or Ⅳ heart failure Recent MI or severe cardiac arrhythmias Persistent uncontrolled hypertension Active psychiatric disease Coexisting nonrespiratory sleep disorders

5. METHODS OUTCOME MEASURES –Primary Outcomes AHI score –The number of apneas per hour of sleep –5–15/hr = mild; 15–30/hr = moderate; and > 30/h = severe ODI score –The number of times per hour of sleep that the blood oxygen level drops by ≥4% from baseline –Secondary Outcomes Epworth Sleepiness Scale (0.0 to 24.0) Functional Outcomes of Sleep Questionnaire (FOSQ) (5.0 to 20.0)

6. METHODS OUTCOME MEASURES –Primary Outcomes AHI score –The number of apneas per hour of sleep –5–15/hr = mild; 15–30/hr = moderate; and > 30/h = severe ODI score –The number of times per hour of sleep that the blood oxygen level drops by ≥4% from baseline –Secondary Outcomes Epworth Sleepiness Scale (0.0 to 24.0) Functional Outcomes of Sleep Questionnaire (FOSQ) (5.0 to 20.0)

7. METHODS FOLLOW-UP –Month 2, 6, and 12 –Epworth Sleepiness Scale score (10.0) –FOSQ score (17.9 or change of >2.0) –Therapy-maintenance group vs. Therapy- withdrawal group Device turned off for 7days in withdrawal group

8. (Tonsils visible beyond the pillars or extending to midline) RESULTS

11. METHODS

12. CONCLUSIONS Upper-airway stimulation led to significant improvements in objective and subjectiv measurements of the severity of obstructive sleep apnea