Home Sleep Testing to Direct Upper Airway Stimulation Therapy Optimization for Sleep Apnea

Abstract

Objectives/Hypothesis: Selective upper airway stimulation (sUAS) is a well-established treatment option for obstructive sleep apnea (OSA). This study aimed to determine if there are benefits in performing a home sleep test (HST) to evaluate postoperative sUAS effectiveness after patient acclimatization compared to the generally used polysomnography (PSG) titration, as measured by long-term follow-up outcomes. Study Design: Retrospective comparative cohort analysis. Methods: We conducted an analysis of consecutive patients at our center who had completed a 6-month follow-up (month 6 [M6]) and recorded data from M6, month 12 (M12), and month 24 (M24). After device activation, we performed an HST with the patient's stimulation settings, and measured the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and device usage. These values were compared to patients who had undergone PSG-based device titration. Results: Baseline values of the initial 131 patients show high ESS and moderate OSA. At the 2-month time point of the HST, nearly half of the patients (46.2%) reached an AHI ≤15/hr, and approximately a fifth (19.2%) reached <5/hr. The PSG and HST groups differed in median ESS at M24, but no other differences were observed for ESS at M6 and M12. Both groups showed similar AHI, oxygen desaturation, and usage hours per week. Conclusions: Adjusting therapy by using the HST technique after device activation and acclimatization has clinical and economic advantages. These advantages are contingent on several conditions being met when deviating from the standard device protocol, including precise communication with the referring sleep medicine physicians, especially their role in helping with long-term follow-up.

Effect of Electrode Configuration and Impulse Strength on Airway Patency in Neurostimulation for Obstructive Sleep Apnea

“…An alternative to the herein used two amplitude levels, FT and 25% increase, could have been strict figures such as 1.0 V and 1.5 V. We decided against it as individual's threshold differ too much, so that 1.5 V could have evoked sensation in one patient and be hardly tolerable in the next. 8,22 We have seen different effects when changing the applied electrode configuration (Table II). However, these differences are so diverse that a general rule of one superior electrode configuration is not possible (Table II).…”

“…In our study, we show that generally a stimulation of 25% above the individual's FT leads to increased airway patency, but the individual's amount of opening and the difference between the opening effects at the level of the velum, tongue base, or epiglottis diverge (Table II). An alternative to the herein used two amplitude levels, FT and 25% increase, could have been strict figures such as 1.0 V and 1.5 V. We decided against it as individual's threshold differ too much, so that 1.5 V could have evoked sensation in one patient and be hardly tolerable in the next 8,22 …”

“…It is not currently possible to give general recommendations regarding electrode configuration such as, for example, elderly and more overweight patients with high AHI who would profit from unipolar settings, whereas non-overweight patients having had a prior UP3 will show good openings with bipolar configurations. Today, as aspects of patient's safety and health economy strongly influence the treatment algorithm for therapy optimization, 22,26 it is unclear whether results from DISE or awake endoscopy are superior for decision-making in further treatment improvement. Taking this into account, we suggest changing electrode configuration under consideration of effects in awake endoscopy and then re-evaluating via home sleep test or even PSG in several weeks after patient is accustomed to the new settings and has increased amplitude.…”

Patienten relevanter Nutzen und Therapieeffekte in der Stimulationstherapie bei schlafbezogenen Atmungsstörungen

“…HNS implantations are activated only after healing phases of several weeks and then adjusted under clinical and polysomnographic control. In selected cases, PSG is even not required [30]. As an example, the setting and therapy control is depicted in ▶Fig.…”

“…Die HNS-Verfahren werden erst nach einer mehrwöchigen Einheilungsphase aktiviert und dann klinisch und polysomnografisch kontrolliert eingestellt, wobei in ausgewählten Fällen auf die PSG ganz verzichtet werden kann [30]. Exemplarisch ist der Einstellungs-und Therapiekontrollverlauf dargestellt (▶ abb.…”