Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Vanderveken, Olivier M.; Maurer, Joachim T.; Hohenhorst, Winfried; Hamans, Evert; Lin, Ho Sheng; Vroegop, Anneclaire V.; Anders, Clemens; Vries, Nico de; Heyning, Paul Van de

doi:10.5664/jcsm.2658

Cited by 269 publications

(273 citation statements)

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“…In this study, the dominant effect of stimulation was the enlargement of the retropalatal and retrolingual airway in the anterior-posterior dimension, which may be due to patient selection, the therapy mechanism, or both. First, patients were pre-selected with retropalatal anterior-posterior collapse, and patients with retropalatal concentric collapse were excluded because of data indicating they would benefit less from the therapy [17]. The stimulation lead was placed to recruit the genioglossus muscle, resulting in an anterior-posterior enlargement of at least the retro-lingual airway area during stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…UAS might be suspected to be of use in patients only with retrolingual collapse; however, empirically, it appears that stimulation may alleviate apnoeas that also have a component of retropalatal collapse [16,17]. While the effect of UAS on retrolingual area can be directly attributed to tongue-base advancement through activation of the genioglossus muscle, the effect of stimulation on retropalatal area is less intuitive.…”

Section: Introductionmentioning

confidence: 99%

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Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

et al. 2014

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Upper-airway stimulation (UAS) using a unilateral implantable neurostimulator for the hypoglossal nerve is an effective therapy for obstructive sleep apnoea patients with continuous positive airway pressure intolerance. This study evaluated stimulation effects on retropalatal and retrolingual dimensions during drug-induced sedation compared with wakefulness to assess mechanistic relationships in response to UAS.Patients with an implanted stimulator underwent nasal video endoscopy while awake and/or during drug-induced sedation in the supine position. The cross-sectional area, anterior-posterior and lateral dimensions of the retropalatal and retrolingual regions were measured during baseline and stimulation.15 patients underwent endoscopy while awake and 12 underwent drug-induced sedation endoscopy. Increased levels of stimulation were associated with increased area of both the retropalatal and retrolingual regions. During wakefulness, a therapeutic level of stimulation increased the retropalatal area by 56.4% ( p=0.002) and retrolingual area by 184.1% ( p=0.006). During stimulation, the retropalatal area enlarged in the anterior-posterior dimension while retrolingual area enlarged in both anterior-posterior and lateral dimensions. During drug-induced sedation endoscopy, the same stimulation increased the retropalatal area by 180.0% ( p=0.002) and retrolingual area by 130.1% ( p=0.008). Therapy responders had larger retropalatal enlargement with stimulation than nonresponders.UAS increases both the retropalatal and retrolingual areas. This multilevel enlargement may explain reductions of the apnoea-hypopnoea index in selected patients receiving this therapy. @ERSpublications Upper-airway stimulation for OSA increases airway dimensions at both the tongue base and the palate

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

et al. 2014

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“…UAS has been shown to safely and effectively maintain airway patency in controlled clinical trials when certain physiological and anatomical criteria are met [9-11]. One of the major selection criteria for therapy response is the absence of a complete concentric collapse in drug-induced sleep endoscopy [12], which is seen in about a fifth of second-line treatment-seeking patients in a German cohort [13]. …”

Section: Introductionmentioning

confidence: 99%

Clinical and Economic Benefits of Upper Airway Stimulation for Obstructive Sleep Apnea in a European Setting

et al. 2019

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Background: Upper airway stimulation (UAS) is a treatment approach for patients with moderate-to-severe obstructive sleep apnea who cannot adhere to continuous positive airway pressure therapy. Objective: The objective was to evaluate added patient benefit and cost-effectiveness of UAS in the German health care system. Methods: We used a decision-analytic Markov model to project major adverse cardiovascular or cerebrovascular events (myocardial infarction [MI] or stroke), motor vehicle collision (MVC), mortality, quality-adjusted life years (QALYs), and costs. The assumed reduction in the apnea-hypopnea index with UAS compared to no treatment is based on German real-world data. Other input data were derived from the literature, public statistics, and multivariate regression. Cost-effectiveness was evaluated in Euros per QALY gained, both discounted at 3%. Results: UAS was projected to reduce event risks (10-year relative risk for stroke, MI, cardiovascular death, and MVC: 0.76, 0.64, 0.65, and 0.34, respectively), and to increase survival by 1.27 years. While the UAS strategy incurred an additional 1.02 QALYs within the patient lifetime, there were also additional costs of EUR 45,196, resulting in an incremental cost-effectiveness ratio of EUR 44,446 per QALY gained. Conclusions: In the present model-based analysis, UAS therapy provides meaningful benefit to patient-relevant endpoints and is a cost-effective therapy in the German setting.

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“…Furthermore, video endoscopic sleep examination is mandatory to identify appropriate candidates for this procedure. As such, this device has limited clinical application 38 but the first clinical data are promising. Over 12 months with a response to therapy were then included in a randomised, controlled trial of therapy withdrawal, which showed a rebound increase in the AHI when upper airway stimulation was withdrawn (to 25.8 per hour from 7.6 per hour, p<0.001).…”

Section: Implantable Cardiac Electronic Devices and Sdb Therapymentioning

confidence: 99%

Cardiac or Other Implantable Electronic Devices and Sleep-disordered Breathing – Implications for Diagnosis and Therapy

Fox¹,

Bitter

Gutleben³

et al. 2014

Arrhythmia &Amp; Electrophysiology Review

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Implantable cardiac devices, such as pacemakers, are used to treat a number of heart conditions, especially those related to the electrical conduction system. Cardiac pacemakers are a well-established and effective therapy, and have been in use for more than 50 years.The first pacemaker was implanted in a patient in October 1958 by Åke Senning in Stockholm, in cooperation with engineer Rune Elmqvist from Siemens. This pioneer work formed the basis of further developments in implantable cardiac device technology, resulting in the devices available today, including implantable cardioverterdefibrillators (ICDs) and biventricular stimulating implanted cardiac resynchronisation therapy (CRT). These newer devices have better effectiveness and a positive impact on patient quality of life (QoL), and are important cardiology treatment strategies.The idea of treating sleep-disordered breathing (SDB) using implantable cardiac devices is not new. In 2002 Garrigue et al. investigated 15 patients with SDB and permanent atrial-synchronous ventricular pacemakers for symptomatic sinus bradycardia using polysomnographic evaluations on consecutive nights. On the basis of one night of treatment, given in a random order, dual-chamber atrial overdrive pacing reduced the apnoea-hypopnoea index (AHI) to 11 ± 14, compared with 28 ± 22 in spontaneous rhythm (p<0.001).1 Initially it had been suggested that atrial pacing would improve SDB in patients with bradycardia, but this hypothesis has not been supported by the results of recent studies. 2,3In addition to their treatment capability, there are a number of algorithms available for today's implantable cardiac devices that allow them to also be used as diagnostic tools. For example, detection of transthoracic impedance has been used to measure respiratory efforts for many years. In addition, for more than a decade many pacemakers have included integrated respiratory minute volume sensors as part of a basic algorithm to adapt the heart rate. 4 Recently, this capability was enhanced to allow detection of cardiac decompensations by measuring changes in intrathoracic fluids.5 A growing number of implantable cardiac devices also now have the ability to detect SDB. 6-8 Sleep-disordered BreathingInterest in SDB among cardiologists is increasing rapidly due to the high prevalence of SDB in patients with cardiovascular disease.The prevalence of SDB in cardiovascular patients is particularly high in those with cardiac dysrhythmias and heart failure (HF; see Figure 1). AbstractSleep-disordered breathing (SDB) is of growing interest in cardiology because SDB is a highly prevalent comorbidity in patients with a variety of cardiovascular diseases. The prevalence of SDB is particularly high in patients with cardiac dysrhythmias and/or heart failure.In this setting, many patients now have implantable cardiac devices, such as pacemakers, implantable cardioverter-defibrillators or implanted cardiac resynchronisation therapy devices (CRT). Treatment of SDB using implantable cardiac devices has been stu...

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Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Cited by 269 publications

References 38 publications

Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

Clinical and Economic Benefits of Upper Airway Stimulation for Obstructive Sleep Apnea in a European Setting

Cardiac or Other Implantable Electronic Devices and Sleep-disordered Breathing – Implications for Diagnosis and Therapy

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