Upper Airway Stimulation in Patients Who Have Undergone Unsuccessful Prior Palate Surgery: An Initial Evaluation

Huntley, Colin; Vasconcellos, Adam; Doghramji, Karl; Hofauer, Benedikt; Heiser, Clemens; Boon, Maurits

doi:10.1177/0194599818792191

Cited by 20 publications

(16 citation statements)

References 9 publications

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“…21 Additionally, no differences in outcomes have been identified between elderly (> 65 years) and nonelderly (< 65 years) cohorts, as well as those with and without prior palatal surgery. 22,23 Values represent mean reduction (preoperative value − postoperative value) ± standard deviation, unless otherwise stated. Definition 1 = AHI reduction > 50% + AHI < 20 events/h.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Lee

Seay

Walters

et al. 2019

Journal of Clinical Sleep Medicine

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Study Objectives: To determine whether therapeutic positive airway pressure (PAP) level predicts response to hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea using the coprimary outcomes of apnea-hypopnea index (AHI) and 4% oxygen desaturation index. Methods: Combined cohort study from two US sleep otolaryngology training programs. Subjects were adults with AHI > 15 events/h who underwent HGNS. Eligible subjects had diagnostic preoperative sleep studies, full-night efficacy postoperative studies and therapeutic PAP levels available for analysis. Low and high PAP groups were compared using the t test for continuous variables and chi-square test for categorical variables. Results: Fifty-six patients met all inclusion criteria. On average, patients were male, Caucasian, middle-aged, and overweight. Thirteen patients were in the low PAP group (< 8 cm H 2 O) and 43 patients in the high PAP group (≥ 8 cm H 2 O). Although both groups experienced improvement of polysomnographic measures with HGNS, the low PAP group achieved a significantly larger mean AHI reduction (36.7 ± 22.7 versus 18.4 ± 23.4, P = .02). Additionally, the low PAP group had a greater response rate (defined as AHI < 20 events/h and > 50% reduction of AHI) than the high PAP group (92% versus 44%, P < .01).Conclusions: Therapeutic PAP level may aid in the discernment of candidacy for HGNS, with a strong positive predictive value for PAP levels < 8 cm H 2 O. A larger prospective study is needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Lee

Seay

Walters

et al. 2019

Journal of Clinical Sleep Medicine

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“…52 A retrospective study showed that prior palatal surgery do not influence HNS clinical outcome. 53,54 Another retrospective analysis found no indication for patients to routinely undergo UPPP before HNS, while palatal surgery could be suggested in case of non-adequate response to HNS after the implantation. 55 Accordingly, a recent study based on the Adhere Registry data (n = 299) showed that previous surgery is not associated with HNS outcomes.…”

Section: Patient Selection and Efficacy Predictorsmentioning

confidence: 99%

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Baptista¹,

Costantino²,

Moffa³

et al. 2020

NSS

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Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m 2 , collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine.

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“…In therapy responders, HNS with respiratory sensing can normalize sleep-related quality of life with very good patient satisfaction [27,28]. Patient age and previous upper airway surgery appear not to affect effectiveness [29,30]. Several retrospective comparative studies show better OSA outcomes of HNS treatment compared to traditional sleep surgery [31][32][33].…”

Section: Overview Of Evidencementioning

confidence: 99%

Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

Steffen

Heiser

Galetke

et al. 2021

Eur Arch Otorhinolaryngol

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Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist. The continuous HNS without respiratory sensing does not require a sleep endoscopy for indication. For the bilateral continuous HNS as the single partially implantable device, a feasibility study exists. For indication, the assessment of positive airway pressure failure by sleep medicine is crucial, and the decision for HNS should be made in discussion of other treatment options for at least moderate OSA. The implantation center holds primarily responsibility among the interdisciplinary sleep team and is primary contact for the patient in problems. This depicts why structural processes are required to secure outcome quality and minimize the complications. The aftercare of HNS patients can be provided interdisciplinary and by different medical institutions, whereat, minimal reporting standards to document outcome and usage are recommended.

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Upper Airway Stimulation in Patients Who Have Undergone Unsuccessful Prior Palate Surgery: An Initial Evaluation

Cited by 20 publications

References 9 publications

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

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