Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry

Abstract

Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients' symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.

Results of the ADHERE upper airway stimulation registry and predictors of therapy efficacy

“…However, approximately one‐third of patients have such difficulty with its chronic use that they seek other options or choose to remain untreated. Upper airway stimulation (UAS) with electrical activation of the hypoglossal nerve has been shown to be a safe and effective treatment option in controlled studies and post‐approval studies in clinical practices. This report details the results of an international registry designed to evaluate efficacy of UAS in patients with moderate to severe OSA and those who could not or would not use CPAP as a primary therapy.…”

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

“…[8][9][10] This appears to be confirmed by preliminary results of a worldwide UAS registry study with no BMI limits. 6 In a cohort of OSA patients looking for PAP treatment alternatives, 20% to 25% had a complete concentric collapse pattern (CCC). 11,12 Findings of this study gained interest because they demonstrated that previous tonsillectomy (TE) reduced prevalence of CCC, which is the major exclusion criterion for UAS, by almost half in a cohort of 210 PAP-intolerant patients.…”

The Impact of Upper Airway Stimulation on Swallowing Function

“…This is likely due to the low incidence of iatrogenic hypoglossal nerve weakness and the lack of alteration of the boney or soft tissue anatomy of the facial skeleton and pharynx. 14 The EAT-10 is a self-administered 10-item measure of symptoms of dysphagia. This instrument, scored on a 0-to 30-point scale, has previously been used to assess presence and severity of swallowing dysfunction and monitor treatment response, with superb test-retest reproducibility and criterion-based validity.…”