Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea

Sarber, Kathleen M.; Ishman, Stacey L.; Patil, Reena Dhanda

doi:10.1001/jamaoto.2018.4077

Cited by 7 publications

(4 citation statements)

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“…Further details on his postoperative course are discussed in a separately published case report. 18 Patient 18 experienced a dramatic reduction in his AHI from 102.9 to 30.8 events/hour on titration PSG, with a CAI of 5.4 events/hour and obstructive AHI of 25.4 events/hour. This patient had both central and obstructive respiratory events on baseline PSG, a phenotype of OSA that is associated with high loop gain and sleep instability.…”

Section: Discussionmentioning

confidence: 93%

“…Our multi‐disciplinary team believed that the central apneas might resolve with adequate treatment by HGNS and thus surgery was offered to this patient. Further details on his postoperative course are discussed in a separately published case report . Patient 18 experienced a dramatic reduction in his AHI from 102.9 to 30.8 events/hour on titration PSG, with a CAI of 5.4 events/hour and obstructive AHI of 25.4 events/hour.…”

Section: Discussionmentioning

confidence: 99%

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Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

et al. 2019

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Objectives The hypoglossal nerve stimulator (HGNS) is currently approved for the treatment of obstructive sleep apnea (OSA) in patients with an apnea‐hypopnea index (AHI) of >15 to ≤65 events/hour, and a central apnea index (CAI) <25% of the AHI, no complete concentric collapse on drug‐induced sleep endoscopy, and a recommended body mass index (BMI) <32 kg/m2. We present 18 patients implanted as a salvage procedure despite being outside these guidelines. Methods We included all patients who underwent HGNS but who did not meet all FDA guidelines. Demographic data, previous OSA treatments, polysomnographic (PSG) parameters from baseline and HGNS titration PSG, Epworth sleepiness score (ESS), and BMI were compared before and after surgery. Results Eighteen patients were identified: 94.4% male, median age 63 years. Seven underwent previous sleep surgery. Four had an AHI <15 (mean 10.5 events/hour), four had an AHI >65 (mean 86.9 events/hour), two had an elevated CAI (mean 31.3% of AHI), and 12 had a BMI >32 kg/m2 (range 32.1–39.1). Median AHI decreased from 25.3 to 3.75 events/hour on titration polysomnography (P = .0006), oxyhemoglobin saturation nadir increased from 82% to 88.5% (P = .0001) and median ESS dropped from 11 to 7.5 (P = .0016). Fifteen (83.3%) patients achieved surgical success (decrease in AHI >50% and AHI <20 events/hour) and 12 (66.7%) had an AHI <5 events/hour. Neither patient with CAI >25% was successfully treated. Median adherence = 33.5 hours/week. Conclusion Our success rate for patients outside the Food and Drug Administration guidelines for HGNS (67%) was similar to the 1‐year STAR trial results (66%). Future studies are necessary to consider expansion of these guidelines. Level of Evidence 4 Laryngoscope, 130:866–872, 2020

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

et al. 2019

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“…In 2018, Chan et al first observed that one patient had a significantly increased CSA during titration. Both OSA and CSA were resolved after the patient’s device configuration was changed to unipolar stimulation and amplitude was calibrated from 0.6 to 1.6 V. In 2019, Sarber et al 3 reported a patient with mixed sleep apnea (CAI of 12.5 event/h) who presented with a TECSA (CAI of 78.9 event/h) and obstructive apnea and hypopnea index of 4.9 event/h with Cheyne-Stokes breathing (CSB) after implantation of HNS. During follow-up, the CSA and CSB continued throughout the study without HNS activation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Nevertheless, a few case reports and one retrospective study reported elevated central sleep apnea (CSA), which has been indicated as an independent predictor of heart failure and could lead to significant comorbidity and an increased risk of adverse cardiovascular outcomes. [2][3][4][5] In 2020, the International Classification of Sleep Disorders-third edition introduced the term "TECSA" (Treatment-Emergent Central Sleep Apnea) and defined it as the presence of primary OSA at the initial diagnostic sleep study, significant resolution of obstructive events with CPAP titration followed by emergence or persistence of central events during PAP treatment with a central apnea index (CAI) ≥5/h, >50% of events being central, and symptoms that cannot be explained in a better manner by another CSA disorder. 6 However, the evidence of TECSA following HNS is limited, especially for the long-term observations.…”

Section: Introductionmentioning

confidence: 99%

Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation

Wang

Penzel

Salanitro

et al. 2022

NSS

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Purpose Since 2001, hypoglossal nerve stimulators (HNS) have been used worldwide to treat patients with obstructive sleep apnea (OSA). Recently, a few studies reported treatment-emergent central sleep apnea (TECSA) with spontaneous resolution following HNS. However, the evidence of persistent development of TECSA during long-term care visits was lacking. As a result, this study first report two patients with persistent TECSA and describe their development phenotype during more than two years of follow-up visits to help explore the influencing factors and underlying mechanisms. Patients and Methods This retrospective study included twenty-seven patients who underwent HNS implantation from 2016 to 2021. Their demographic data, pre- and postoperative sleep study characteristics, and device use settings were collected. The possible factors associated with post-operative elevated CSA (central apnea index ≥5) were evaluated. Moreover, the development phenotype of the TECSA was observed and followed up with a titration trial study. Results Among overall 27 patients with OSA, 3 patients with an increased preoperative Epworth Sleepiness Score (ESS) got an elevated CSA (CAI ≥ 5). Two of these 3 patients developed a persistent TECSA with a significant negative correlation between obstructive apnea index (OAI) and central and mixed sleep apnea index (CMAI) (R = −0.745, P = 0.021). These development phenotypes might be associated with different stimulation amplitudes of the HNS device. Furthermore, the following titration trial study also suggested that different amplitudes would influence the development of TECSA following HNS. Conclusion OSA patients with severe daytime sleepiness are more likely to have elevated CSA following HNS. An inappropriate stimulation amplitude might influence the development course of TECSA in such patients.

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Hypoglossal Nerve Stimulation in Veterans with Obstructive Sleep Apnea

et al. 2019

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ObjectivesThe hypoglossal nerve stimulator (HNS) is an effective treatment for obstructive sleep apnea (OSA) in a relatively healthy subset of the population. Our aim was to determine the efficacy of HNS in a veteran population with a high incidence of chronic disease and mental health disorders. Our secondary aim was to compare subjective outcomes and adherence between veterans with and without mental health disorders.MethodsWe included all patients who underwent HNS at our institution to date. Veterans were divided into two groups based on whether or not they carried a diagnosis of anxiety, depression, and/or post‐traumatic stress disorder. Demographics, comorbidities, previous OSA treatments, adverse events, and adherence to therapy were recorded. Baseline and treatment outcome data were collected and analyzed including polysomnographic parameters, Epworth sleepiness scale score (ESS), and body mass index.ResultsThirty‐one patients were identified: 93.5% male, median age = 63.0 years. Median apnea hypopnea index (AHI) decreased from 30.0 to 3.0 events/hour (P < .001) and median ESS dropped from 11.0 to 6.5 (P < .001). There was no difference between groups with regard to change in AHI or ESS (P = .31 and .61). Twenty‐six (89.7%) patients achieved surgical success (decrease in AHI > 50% and AHI < 20 events/hour) and 21 (72.4%) had AHI < 5 events/hour. The mean device usage was 5.4 hours/night which was not significantly different between groups (P = .55).ConclusionOur cohort exhibited similar declines in AHI and ESS compared to published studies with adequate adherence to HNS. There were no significant differences in ESS or adherence to therapy between veterans with and without mental health disorders.Level of Evidence4 Laryngoscope, 130:2275–2280, 2020

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Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea

Abstract: Fleming JJ. The decline of venture capital investment in early-stage life sciences poses a challenge to continued innovation.

Cited by 7 publications

References 6 publications

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations

Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation

Hypoglossal Nerve Stimulation in Veterans with Obstructive Sleep Apnea

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