Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: An Evaluation and Comparison of Outcomes at Two Academic Centers

Abstract

undergoing upper airway stimulation (UAS) were analyzed. We hypothesize that treatment with UAS will improve both subjective and objective outcome measures and results will be reproducible between institutions. Methods: We reviewed patients undergoing UAS between May 2014 and August 2016. We recorded demographic data, Epworth Sleepiness Scale (ESS), and preoperative and postoperative polysomnographic information. We compared outcome data between institutions and subsequently combined the cohorts and compared baseline to posttreatment results. Results: The TJUH cohort consisted of 30 males and 18 females with a mean age of 60.88 years and body mass index of 29.29. The mean preoperative apnea-hypopnea index (AHI), O2 nadir, and ESS were 35.88, 80.96, and 11.09, respectively. The mean postoperative AHI, O2 nadir, and ESS were 6.34, 88.04, and 5.77, respectively. The UPMC cohort consisted of 30 males and 19 females with a mean age of 62.84 years and body mass index of 27.74. The mean preoperative AHI, O2 nadir, and ESS were 35.29, 79.58, and 10.94, respectively. The mean postoperative AHI, O2 nadir, and ESS were 6.28, 84.35, and 6.60, respectively. We found no difference in patients reaching a postoperative AHI less than 15, 10, and 5 when comparing the cohorts. After combining cohorts, we found a significant improvement in postoperative AHI, O2 nadir, and ESS compared to preoperative values. Conclusions: UAS appears to provide a viable alternative to continuous positive airway pressure, producing improvement in both polysomnographic and quality-of-life measures. Results are reproducible at high-volume centers.

Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi‐institutional Review

“…25 Huntley et al reviewed and compared the outcomes at two high-volume academic centers and found a significant improvement in AHI and ESS at both institutions with comparable results. 26 The findings in this study suggest that UAS can still be effective in patients with an elevated BMI, providing they have appropriate preoperative drug-induced sleep endoscopy findings. In our cohort, using a BMI cutoff of 32 kg/m 2 , there was no difference in postoperative PSG outcomes, ESS score, rate of surgical success, or percent of patients reaching a postoperative AHI less than 15 or 5 when comparing the elevated BMI patients to those with a BMI less than 32.…”

“…Kent et al evaluated 20 patients undergoing UAS implantation and found a significant improvement in both AHI and ESS with treatment . Huntley et al reviewed and compared the outcomes at two high‐volume academic centers and found a significant improvement in AHI and ESS at both institutions with comparable results …”

Comparing Upper Airway Stimulation to Transoral Robotic Base of Tongue Resection for Treatment of Obstructive Sleep Apnea

“…In combining the cohorts, there was a significant improvement in AHI, O 2 desaturation nadir, and ESS postoperatively. Comparing the two cohorts, there was no difference in postoperative AHI or the rate of surgical success, suggesting reproducible results at high volume centers . Heiser et al evaluated their cohort of patients with sleep studies at 2, 3, 6, and 12 months after implantation.…”

“…Comparing the two cohorts, there was no difference in postoperative AHI or the rate of surgical success, suggesting reproducible results at high volume centers. 24 Heiser et al evaluated their cohort of patients with sleep studies at 2, 3, 6, and 12 months after implantation. They found a significant improvement in AHI, oxygen desaturation index, and ESS at the 12-month evaluation compared to baseline.…”

Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series

“…Upper airway stimulation (UAS) has demonstrated marked improvements in apnea-hypopnea index (AHI), oxygen desaturation index, and quality-of-life measures in patients with moderate-to-severe obstructive sleep apnea (OSA) who are unable to tolerate continuous positive airway pressure (CPAP). [1][2][3][4][5][6] There have been few documented procedure or device-related adverse events. These have included tongue soreness, discomfort with stimulation, and device migration.…”