Palatal Coupling Maneuvers Do Not Predict Hypoglossal Nerve Stimulator Treatment Efficacy

Abstract

Objective(s): Maneuvers during drug-induced sleep endoscopy (DISE), for patients with obstructive sleep apnea (OSA), have been used as predictors for success with oral appliances. Hypoglossal nerve stimulation (HGNS) promotes opening at the velum through palatoglossus coupling. In this study, we evaluate maneuvers during DISE as predictors for HGNS treatment efficacy.Methods: We evaluated patients undergoing HGNS between November, 2014 and February, 2021. We assessed maneuvers including jaw thrust and chin lift during preoperative DISE. The impact of tongue base and palatal opening during these maneuvers were rated from 1 to 4 (1: no improvement, 2: mild improvement, 3: moderate improvement, 4: significant improvement). Patients were grouped by a score of 1-2 (weak response) or 3-4 (strong response). Apnea hypopnea index (AHI) change was calculated from the difference between preoperative and postoperative sleep study.Results: One hundred and seventy one patients were included. With jaw thrust, there was no significant difference in AHI change between patients with weak or strong response at the palate (n = 68 vs. 94, 9.5 vs. 13.6, p = 0.21) or tongue base (n = 24 vs. 138, 16.6 vs. 11.3, p = 0.24). On chin lift, there was no significant difference at the palate (n = 82 vs. 18, 13.9 vs. 11.4, p = 0.63) or tongue base (n = 92 vs. 72, 10.8 vs. 14.6, p = 0.24). On multiple linear regression analysis, lower body mass index, higher preoperative AHI, and higher preoperative oxygen nadir were associated with a larger AHI change.Conclusion: Palatal coupling maneuvers during DISE are not predictive of AHI change with HGNS. Findings using these maneuvers should not preclude HGNS candidacy.

Troubleshooting Upper Airway Stimulation Therapy Using Drug‐Induced Sleep Endoscopy

“…In this study, 33% of patients had significant lateral wall collapse with and without UAS therapy. PC is another active area of interest in predicting response to OSA therapies with several studies supporting its use in predicting oral appliance therapy success but mixed results for UAS 15‐17 …”

“…PC is another active area of interest in predicting response to OSA therapies with several studies supporting its use in predicting oral appliance therapy success but mixed results for UAS. [15][16][17] In regard to ITT or Yellow Type 1 patients, there is limited literature, and most of the current knowledge for these patients centers around comorbid insomnia and OSA and its impact on device usage. [18][19][20] Our ITT patients made up 4% of our total UAS sample and accounted for 44% of the patients who underwent DISE-UAS.…”