Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?

Renslo, Bryan; Virgen, Celina; Sawaf, Tuleen; Arambula, Alexandra; Sykes, Kevin J.; Larsen, Christopher G.; Rouse, David

doi:10.5664/jcsm.10496

Cited by 1 publication

(4 citation statements)

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“…However, this lack of knowledge about supine-dependent OSA was not proportionally different between groups and therefore was unlikely to bias any effect estimates. It is possible that BMI changes between the preimplantation and postimplantation sleep study could affect the validity of our findings . However, there was only a median (IQR) difference of 13 (9-23.5) months between studies and a difference in BMI of only 0.39 (95% CI, 0.23-0.50).…”

Section: Discussionmentioning

confidence: 75%

“…Previous studies have reported conflicting findings regarding the association between BMI and response to HGNS treatment. [24][25][26] Medicare guidelines now allow for HGNS device implantation in patients with a BMI of 35 or less. Our findings indicate that while some patients with a BMI of 32 to 35 respond to HGNS treatment, their odds of achieving a treatment response are reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported conflicting findings regarding the association between BMI and response to HGNS treatment . Medicare guidelines now allow for HGNS device implantation in patients with a BMI of 35 or less.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that BMI changes between the preimplantation and postimplantation sleep study could affect the validity of our findings. 25 However, there was only a median (IQR) difference of 13 (9-23.5) months between studies and a difference in BMI of only 0.39 (95% CI, 0.23-0.50). Another limitation is the lack of subjective rating scales to complement the objective changes in AHI, limiting understanding of patients' subjective experiences with HGNS treatment.…”

Section: Limitationsmentioning

confidence: 93%

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Response to Hypoglossal Nerve Stimulation Changes With Body Mass Index and Supine Sleep

Patel,

Wang,

Jamro

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceHypoglossal nerve stimulation (HGNS) is a potential alternative therapy for obstructive sleep apnea (OSA), but its efficacy in a clinical setting and the impact of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) on treatment response remain unclear.ObjectiveTo investigate whether HGNS therapy is effective for patients with OSA, whether HGNS can treat supine OSA, and whether there are associations between BMI and treatment response.Design, Setting, and ParticipantsIn this cohort study, adult patients with OSA implanted with HGNS at the Washington University Medical Center in St Louis from April 2019 to January 2023 were included. Data were analyzed from January 2023 to January 2024.ExposureHGNS.Main Outcomes and MeasuresMultivariable logistic regression was performed to assess associations between HGNS treatment response and both BMI and supine sleep. Treatment response was defined as 50% reduction or greater in preimplantation Apnea-Hypopnea Index (AHI) score and postimplantation AHI of less than 15 events per hour.ResultsOf 76 included patients, 57 (75%) were male, and the median (IQR) age was 61 (51-68) years. A total of 59 patients (78%) achieved a treatment response. There was a clinically meaningful reduction in median (IQR) AHI, from 29.3 (23.1-42.8) events per hour preimplantation to 5.3 (2.6-12.3) events per hour postimplantation (Hodges-Lehman difference of 23.0; 95% CI, 22.6-23.4). In adjusted analyses, patients with BMI of 32 to 35 had 75% lower odds of responding to HGNS compared with those with a BMI of 32 or less (odds ratio, 0.25; 95% CI, 0.07-0.94). Of 44 patients who slept in a supine position, 17 (39%) achieved a treatment response, with a clinically meaningful reduction in median (IQR) supine AHI from 46.3 (33.6-63.2) events per hour preimplantation to 21.8 (4.30-42.6) events per hour postimplantation (Hodges-Lehman difference of 24.6; 95% CI, 23.1-26.5). In adjusted analysis, BMI was associated with lower odds of responding to HGNS with supine AHI treatment response (odds ratio, 0.39; 95% CI, 0.04-2.59), but the imprecision of the estimate prevents making a definitive conclusion.Conclusions and RelevanceThis study adds to the growing body of literature supporting the use of HGNS for OSA treatment. Sleep medicine clinicians should consider informing patients that higher BMI and supine sleeping position may decrease therapeutic response to HGNS. Future research is needed to replicate these findings in larger, more diverse cohorts, which would facilitate the optimization of treatment strategies and patient counseling for HGNS therapy.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 93%

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