Efficacy of Upper Airway Stimulation on Collapse Patterns Observed during Drug‐Induced Sedation Endoscopy

Ong, Adrian A.; Murphey, Alexander W.; Nguyen, Shaun A.; Soose, Ryan J.; Woodson, B. Tucker; Vanderveken, Olivier M.; Vries, Nico de; Gillespie, M. Boyd

doi:10.1177/0194599816636835

Cited by 46 publications

(47 citation statements)

References 43 publications

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“…This is generally accepted among UAS surgeons at established implanting centers when selecting patients for UAS therapy. Several studies on DISE cohorts of patients with PAP intolerance found CCC in about 20% to 25% . The fact that hypoglossal nerve activation enlarges not only the lower pharynx but also the velum region is explained by the palatoglossal coupling .…”

Section: Discussionmentioning

confidence: 98%

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

et al. 2018

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Objective Upper airway stimulation (UAS) is an effective second‐line treatment for obstructive sleep apnea (OSA). In certain patients, there is a considerable need for advanced programming, notably with inadequate palatal response to therapy. The aim of the study was to investigate the impact of uvulopalatopharyngoplasty and tonsillectomy (UPPP‐TE) on UAS therapy outcomes from a 2‐year perspective after implantation. Methods This study included all consecutive patients implanted with UAS in which a full set of 1‐ and 2‐year follow‐up assessments (M12 and M24) were obtained. Cases were analyzed in three groups: patients with UPPP‐TE after (group 1) and before (group 2) UAS, and those without UPPP‐TE (group 3). Results Therapy success could be achieved in about 80% of the entire cohort. Groups 2 and 3 did not differ significantly with regard to obesity, Apnea‐Hypopnea Index, or Oxygen Desaturation Index. With regard to initial sleep endoscopy, there were fewer patients without any obstruction at the palatal and oropharyngeal levels and higher prevalence of lateral obstruction patterns at oropharynx in group 1 in contrast to groups 2 and 3. Groups 2 and 3 showed similar results, although group 2 patients underwent UPPP‐TE before UAS implantation. Conclusion UPPP‐TE should be considered in patients with persistent OSA after UAS implantation if the obstruction is identified at the level of velum and oropharynx. Although this approach has higher response rates and better outcomes can be achieved in patients with UAS, there is no indication for patients to routinely undergo UPPP‐TE prior to UAS implantation. Level of Evidence 4 Laryngoscope, 129:514–518, 2019

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Section: Discussionmentioning

confidence: 98%

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

et al. 2018

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“…The results of the present prospective study, in a population of 14 patients who underwent MAD treatment followed by MMA surgery, show that a complete elimination of CCCp can be achieved by MMA surgery. This is of major importance, as CCCp is considered to be a negative predictive value for MAD treatment, UA surgery, and UA stimulation, and tends to be more difficult to alleviate compared to the other collapse patterns . In addition, when CCCp is present, higher CPAP pressure is needed to reopen the UA …”

Section: Discussionmentioning

confidence: 99%

“…This can be performed by drug‐induced sleep endoscopy (DISE) mimicking natural sleep . A complete concentric collapse at the level of the palate (CCCp), as observed during DISE, has been a reported predictor for decreased success rate of some specific non‐CPAP treatment options such as UA stimulation, UA surgery, and MAD . Specifically, surgical treatment with UA stimulation, using electrical neurostimulation of the hypoglossal nerve synchronized with ventilation, fails to reduce OSA severity in patients with CCCp .…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, surgical treatment with UA stimulation, using electrical neurostimulation of the hypoglossal nerve synchronized with ventilation, fails to reduce OSA severity in patients with CCCp . Consequently, according to the Food and Drug Administration approval statement, CCCp became a formal exclusion criterion for UA stimulation therapy …”

Section: Introductionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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“…The mechanism of action of the UAS is electrical stimulation of the genioglossus muscle causing the tongue to thrust forward. Multiple studies now indicate that the area of obstruction in OSA is at the level of the velopharynx and tongue base . Studies demonstrate that the volume of the air column increases both anterior‐posterior and laterally at the level of the palate‐lingual pharynx and anterior and posteriorly at the level of the velopharynx …”

Section: Discussionmentioning

confidence: 99%

Hypoglossal Nerve Stimulator Implantation in a Non‐Academic Setting: Two‐Year Result

Weeks¹,

Bao

Gilbert

et al. 2018

Laryngoscope Investig Oto

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Objectives/HypothesisUpper Airway Stimulation (UAS) is an FDA approved treatment option for patients with moderate‐to‐severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure (CPAP). Previous studies have shown UAS reduced apnea‐hypopnea index (AHI) in controlled clinical trials and from academic institutions. We report patient outcomes and therapy adherence of UAS in a non‐academic hospital and clinic setting.Study DesignCase series of consecutive patients.MethodsConsecutive implants completed at a community hospital between January 2015 to Feb 2017 are included in this report. All patients underwent baseline polysomnography (PSG) recording and drug‐induced sleep endoscopy (DISE) prior to the implant. All patients had returned for standard post‐implantation titration PSG at a community sleep clinic to validate and adjust the stimulation setting for optimal response. Results were in mean ± SD, and pre‐ and post‐implant data were compared using a paired student t‐test.ResultsA total 22 patients undergoing UAS implant were overweight (BMI of 28.9 ± 5.0 kg/m2) and middle aged (63.2 ± 11.1 years), and had severe OSA (AHI of 35.9 ± 19.1). The AHI from the entire night of the titration study was 16.0 ± 10.4 (P < .01, compared with baseline), and the treatment AHI from the sleep period when the optimal setting was programmed was 1.2 ± 1.1 (P < .001, compared with baseline), and 90% patients had titrated AHI less than 5. The lowest SpO2 increased from 81% ± 8% at baseline to 91% ± 3% at the titrated setting (P = .001). After an average follow up of 95 ± 28.5 days, the therapy use per night was 7.0 ± 1.9 hours per night. The average postoperative ESS was 6.7 ± 5.3 of 18 patients, a reduction from the baseline of 10.9 ± 4.8. A total of 13 of 18 patients with postoperative ESS < 10, a measure indicated normalization of daytime sleepiness.ConclusionPatients who elected to receive UAS implant surgery at a non‐academic hospital and followed at a sleep clinic showed significant reduction in OSA severity with strong adherence to treatment. These results supported that UAS as a valid treatment option for OSA can be successfully implemented in the non‐academic hospital and clinic settings.Level of Evidence4

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Efficacy of Upper Airway Stimulation on Collapse Patterns Observed during Drug‐Induced Sedation Endoscopy

Cited by 46 publications

References 43 publications

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Hypoglossal Nerve Stimulator Implantation in a Non‐Academic Setting: Two‐Year Result

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