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Qi Y, Zhao Y, Yan Y, Wu D. Surgical failure guided by DISE in patients with obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3333-3343. [PMID: 38324055 DOI: 10.1007/s00405-024-08484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This review aims to analyze the failure rate of upper airway surgery with DISE and identify obstruction sites for surgical failure. METHODS A systematic review was conducted using PubMed, Embase, Web of Science, and Google Scholar until May 20th, 2023. We included studies that used DISE to assess obstructive sites before upper airway surgery and reported surgical failure rates and outcomes in patients with OSA. RESULTS 25 studies with a total of 1522 patients were included in the systematic review and meta-analysis. Upper airway surgery guided by DISE had a relatively low failure rate of 37% (95% CI 0.31-0.44) in the random effects model (I2 = 85.97%, P < 0.001). According to the velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system, major risk factors for surgical failure included circumferential collapse at the velum, lateral wall collapse and small tonsils at the oropharynx, anterior-posterior lingual collapse and complete collapse at the tongue base. High body mass index and large preoperative apnea hypopnea index were also risk factors for OSA surgical failure. CONCLUSIONS Upper airway surgery guided by DISE in patients with OSA had a low failure rate of 37%. DISE can identify obstruction sites associated with surgical failure and guide single-level and multi-level surgeries.
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Affiliation(s)
- Yingting Qi
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Medicine, Peking University, Beijing, People's Republic of China
| | - Yi Zhao
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Medicine, Peking University, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
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Habetha S, Sauermann S, Müller S, Gottschalk G. [Ten years of hypoglossal nerve stimulation in obstructive sleep apnea: a systematic literature review]. Pneumologie 2024. [PMID: 38914119 DOI: 10.1055/a-2331-8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To show the importance of hypoglossal nerve stimulation (HGNS) as a treatment method for obstructive sleep apnea (OSA) in the German healthcare context and to better assess the way patients who do not receive adequate care could benefit from HGNS. METHODS A systematic literature review in the Medline and Cochrane Library literature database was conducted, including publications using different stimulation technologies for HGNS. The efficacy of HGNS was assessed based on patient-relevant outcomes (daytime sleepiness, quality of life), treatment adherence and the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The safety of the treatment method was assessed based on adverse events (AEs). RESULTS Inclusion and analysis of 33 publications: 2 randomized controlled trials (RCTs, level Ib), 1 level IIb trial (n = 1) and 30 level IV trials with a study duration of up to 60 months. The RCTs showed better values for daytime sleepiness and quality of life when using HGNS than in the control group. AHI and ODI showed a deterioration under placebo stimulation or therapy withdrawal in the RCTs. Consistently high adherence was also reported in the long-term course. Severe AEs under HGNS were rare and could usually be resolved by repositioning electrodes or replacing device components. Other AEs were mostly transient or could be resolved by non-invasive measures. All investigated parameters showed similar results in the evaluated studies. The results of different stimulation systems are comparable in type and extent. CONCLUSION The comprehensive review of the literature shows consistent data that highlight the importance of HGNS as an effective and safe treatment for OSA after unsuccessful CPAP treatment. The evaluation also shows that the different stimulation systems make it possible to better tailor the therapy to the patient's individual requirements. A future systematic evaluation of real-world data on the use of HGNS would help gain additional insights into the relevance of the method in routine clinical practice.
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Braun M, Wollny M, Schoebel C, Sommer JU, Heiser C. Patient-reported experience with hypoglossal nerve stimulation in the treatment of obstructive sleep apnea. Sleep Breath 2024; 28:221-230. [PMID: 37542679 PMCID: PMC10955022 DOI: 10.1007/s11325-023-02887-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Breathing-synchronized hypoglossal nerve stimulation (HNS) is routinely used as an alternative treatment for patients with obstructive sleep apnea (OSA). Significant and clinically relevant improvements in disease severity and OSA symptoms such as daytime sleepiness as well as overall quality of life have been reported in randomized-controlled trials and large real-world cohort studies. However, so far, few data exist on patient-reported experience with the treatment. METHODS A structured survey with 22 questions was constructed using five-level Likert scales (1 = no agreement, 5 = complete agreement) to evaluate patient experience with HNS and perception of the treatment in the domains "Overall experience with therapy," "Experience with treatment process," and "Side-effects from treatment." Additional data were collected on current symptom status, measured with Epworth sleepiness scale (ESS) questionnaire, and OSA disease history. Multiple linear regression analysis was conducted to test associations of medical variables and response behavior. Correlations between variables and domains, as well as individual items, were assessed using Spearman rank test. RESULTS A total of 75 patients from Germany who were treated with breathing-synchronized HNS were enrolled (mean age 57.3 years, 78% male), and 71 questionnaires with complete data were included for analysis. Two-thirds of participants (67%) had a history of OSA history for 5 years or longer. Of all patients, 76% had normalized OSA symptoms at time of the study (ESS: 6.4 ± 5.0) and 98% reported using stimulation therapy every night. Regression analysis revealed an association of current symptoms measured with ESS and response behavior. Hence, patients with normalized daytime sleepiness reported significantly more positive experience across all domains assessed, compared to patients with residual daytime sleepiness. Overall, only 2% of participants reported side effects that made them reduce or discontinue stimulation therapy. The rate of reported side effects was associated with current symptom control under therapy. CONCLUSIONS Overall patient-reported experience with breathing-synchronized HNS therapy was positive and high satisfaction with the treatment process was observed. Side effects occurred, but rarely affected subjective use of the therapy or satisfaction. Subjective experience and perception are influenced by residual daytime sleepiness with stimulation therapy.
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Affiliation(s)
- M Braun
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany.
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany.
| | - M Wollny
- MedImbursement, Tarmstedt, Germany
| | - C Schoebel
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany
| | - J U Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- ENT-Center Mangfall-Inn, Bad Aibling, Germany
| | - C Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Kim DH, Kim SW, Han JS, Kim GJ, Basurrah MA, Hwang SH. Hypoglossal Nerve Stimulation Effects on Obstructive Sleep Apnea Over Time: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:736-746. [PMID: 38123511 DOI: 10.1002/ohn.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to determine the efficacy of hypoglossal nerve stimulation (HGS) in the treatment of obstructive sleep apnea. DATA SOURCES PubMed, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar. REVIEW METHODS Five databases were reviewed to identify relevant studies that measured polysomnography parameters such as the apnea-hypopnea index (AHI) and oxygen desaturation index, as well as quality of life and functional outcomes of sleep questionnaire scores, before and after HGS. RESULTS In total, 44 studies involving 8670 patients met the inclusion criteria. At 12 months after treatment, approximately 47%, 72%, and 82% of patients achieved AHI values of <5, < 10, and <15, respectively. The reported clinical success rates according to Sher criteria were 80% within 12 months and 73% between 12 and 36 months. While the favorable effects exhibited a gradual reduction up to 12 months postimplantation, they generally maintained a consistent level between the 12th and 36th months, as assessed by AHI < 5, <15, and success rate according to Sher criteria. CONCLUSION HGS can enhance quality of life scores and polysomnography outcomes in obstructive sleep apnea patients. Although the positive effects gradually decreased until 12 months after implantation, they generally remained consistent between 12 and 36 months.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Saltagi MZ, Powell K, Saltagi AK, Stahl S, Manchanda S, Parker NP. Novel Outcome Analysis Tool for Hypoglossal Nerve Stimulator Sensor Lead Function and Comparison by Incision Type (2 Versus 3). Laryngoscope 2023; 133:423-430. [PMID: 36054604 PMCID: PMC10087886 DOI: 10.1002/lary.30365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE No reported outcome measures have been established to evaluate sensor lead function in the hypoglossal nerve stimulator (HNS). This study describes the development of novel functional outcome measures for intraoperative sensor electrode function and compares 2-incision and 3-incision outcomes for HNS. METHODS A retrospective cohort study of 100 consecutive patients who underwent HNS between June 2019 and September 2021. Demographic information, intraoperative findings, and immediate postoperative outcomes were recorded. Structured parameters were developed to compare intraoperative waveforms with six outcome measures utilized: waveform syncing, waveform amplitude, sensory current leakage, shark-fin morphology, cardiac artifact, and overall impression. Two sleep surgeons and two sleep medicine specialists compared all waveforms in a blinded fashion and assigned scores on the Likert Scale. RESULTS The cohort included 50 three-incision and 50 two-incision patients. Age, gender, average body mass index, comorbidity profiles, and sleep endoscopy findings did not significantly differ between the two groups. No major complications occurred. The interclass-correlation-coefficient was greater than 0.7 for all comparisons (good to very good interrater reliability). There was no difference in waveform amplitude, cardiac artifact, sensory current leakage, or shark-fin morphology between the two groups. Waveform syncing and overall impression were statistically better in the 2-incision cohort. CONCLUSIONS This study is the first to define a structured method of HNS sensor electrode outcome measurement and showed consistent measures by surgeons and sleep medicine specialists. This article supports the transition to the 2-incision technique among surgeons for placement of the sensor lead. Consideration should be given to utilizing this novel tool in the clinical/research setting and validating these measures moving forward. LEVEL OF EVIDENCE 3 Laryngoscope, 133:423-430, 2023.
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Affiliation(s)
- Mohamad Z Saltagi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Kayla Powell
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Abdul K Saltagi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Stephanie Stahl
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Shalini Manchanda
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Noah P Parker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.,Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Maxillomandibular Advancement and Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: A Systematic Review. J Clin Med 2022; 11:jcm11226782. [PMID: 36431259 PMCID: PMC9697253 DOI: 10.3390/jcm11226782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment.
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Verbraecken J, Dieltjens M, Op de Beeck S, Vroegop A, Braem M, Vanderveken O, Randerath W. Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheff) 2022; 18:220164. [PMID: 36340820 PMCID: PMC9584565 DOI: 10.1183/20734735.0164-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
Treatment of obstructive sleep apnoea in adults is evolving, from a "one treatment fits all" to a more individualised approach. The spectrum of treatment options is broad and heterogeneous, including conservative, technological and pharmaceutical modalities. This raises the questions of which patients these modalities might be useful for, and if there are specific criteria for single or combined treatment. The most commonly used non-CPAP treatment is a mandibular advancement device. Furthermore, it appears from the available evidence that upper airway surgery, bariatric surgery, and maxillomandibular advancement can be effective in particular patient groups and should be indicated more readily in clinical practice. Technically, a tracheotomy is the most effective surgical treatment, but is not socially acceptable and is associated with major side-effects. Other treatment options are emerging, like positional therapy, hypoglossal nerve stimulation, and myofunctional exercises. Drug therapy is also promising when pathophysiological traits are considered. The range of currently available treatment options will be discussed in this review, with emphasis on the selection of appropriate patients, therapeutic efficacy and compliance, and reference to recent guidelines. In the selection process, routine application of drug-induced sleep endoscopy to assess the site(s) of collapse during sleep can increase the success rate of both surgical interventions and oral appliance therapy. Educational aims To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine, Antwerp University Hospital, Edegem (Antwerp), Belgium,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Corresponding author: Johan Verbraecken ()
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Anneclaire Vroegop
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Jomha M, Dabboussi T, Parker NP, Manchanda S, Chernyak Y, Stahl SM. Prevalence of Insomnia and Restless Legs Syndrome in Patients with Upper Airway Stimulation Therapy and Effects on Treatment Outcomes. Sleep Med 2022; 98:121-126. [DOI: 10.1016/j.sleep.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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10
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Baptista PM, Prieto-Matos C, Alegre-Esteban M, Urrestarazu-Bolumburu E, Alcade Navarrete J. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2022; 74:158-165. [DOI: 10.1007/s12070-021-02503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
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11
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Van den Bossche K, Van de Perck E, Wellman A, Kazemeini E, Willemen M, Verbraecken J, Vanderveken OM, Vena D, Op de Beeck S. Comparison of Drug-Induced Sleep Endoscopy and Natural Sleep Endoscopy in the Assessment of Upper Airway Pathophysiology During Sleep: Protocol and Study Design. Front Neurol 2021; 12:768973. [PMID: 34950101 PMCID: PMC8690862 DOI: 10.3389/fneur.2021.768973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Study Objectives: Obstructive sleep apnea (OSA) is increasingly recognized as a complex and heterogenous disorder. As a result, a "one-size-fits-all" management approach should be avoided. Therefore, evaluation of pathophysiological endotyping in OSA patients is emphasized, with upper airway collapse during sleep as one of the main features. To assess the site(s) and pattern(s) of upper airway collapse, natural sleep endoscopy (NSE) is defined as the gold standard. As NSE is labor-intensive and time-consuming, it is not feasible in routine practice. Instead, drug-induced sleep endoscopy (DISE) is the most frequently used technique and can be considered as the clinical standard. Flow shape and snoring analysis are non-invasive measurement techniques, yet are still evolving. Although DISE is used as the clinical alternative to assess upper airway collapse, associations between DISE and NSE observations, and associated flow and snoring signals, have not been quantified satisfactorily. In the current project we aim to compare upper airway collapse identified in patients with OSA using endoscopic techniques as well as flow shape analysis and analysis of tracheal snoring sounds between natural and drug-induced sleep. Methods: This study is a blinded prospective comparative multicenter cohort study. The study population will consist of adult patients with a recent diagnosis of OSA. Eligible patients will undergo a polysomnography (PSG) with NSE overnight and a DISE within 3 months. During DISE the upper airway is assessed under sedation by an experienced ear, nose, throat (ENT) surgeon using a flexible fiberoptic endoscope in the operating theater. In contrast to DISE, NSE is performed during natural sleep using a pediatric bronchoscope. During research DISE and NSE, the standard set-up is expanded with additional PSG measurements, including gold standard flow and analysis of tracheal snoring sounds. Conclusions: This project will be one of the first studies to formally compare collapse patterns during natural and drug-induced sleep. Moreover, this will be, to the authors' best knowledge, the first comparative research in airflow shape and tracheal snoring sounds analysis between DISE and NSE. These novel and non-invasive diagnostic methods studying upper airway mechanics during sleep will be simultaneously validated against DISE and NSE. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04729478.
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Affiliation(s)
- Karlien Van den Bossche
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Eli Van de Perck
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Elahe Kazemeini
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Op de Beeck
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Edegem, Belgium
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12
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Bosschieter PFN, Schoustra E, de Vries N, Steinbusch MJL, Kasius KM, Ravesloot MJL. Daytime polysomnography to perform titration for upper airway stimulation in patients with obstructive sleep apnea. Sleep Breath 2021; 26:707-715. [PMID: 34319499 PMCID: PMC8316890 DOI: 10.1007/s11325-021-02441-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
Purpose Upper airway stimulation (UAS) is an innovative treatment for patients with obstructive sleep apnea (OSA). UAS titrations are performed 3 months after activation of the device to optimize its effectiveness. In general, these titrations are performed during an in-laboratory overnight polysomnography (PSG). However, overnight titrations are expensive and can be logistically challenging because they are labor-intensive which causes shortage of sleep technicians available for night shifts. In addition, recently, overnight PSGs were postponed and canceled due to the COVID-19 pandemic. We aimed to assess the feasibility of a daytime PSG to perform titration of UAS therapy as an alternative for a conventional overnight PSG. Methods We performed a prospective single-center observational cohort study. Patients were included when planned for UAS titration; this was approximately 6 months after UAS activation. Data on sleep architecture, patient experience, and respiratory outcomes were collected to evaluate the feasibility. An overnight follow-up PSG 12 months after implantation was used to compare sleep architecture and therapy response. Results Of 23 patients, four were excluded from analysis because of technical issues during PSG. Even though patients slept significantly shorter during the daytime PSG, this was enough time to complete the titration successfully with 30-min sleep in final therapeutic settings in 84% of the patients. Patients (94%) had a positive experience with the daytime titration. Respiratory outcomes were significantly reduced during titration and were maintained at the 12-month follow-up. Conclusion Daytime titrations are a valuable alternative for conventional overnight titrations. Our findings suggest the implementation of daytime titrations as standard of care. This will contribute to easier logistics and better work circumstances for sleep technicians without jeopardizing titration quality.
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Affiliation(s)
- Pien F N Bosschieter
- Department of Otorhinolaryngology - Head and Neck Surgery , OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.
| | - Emily Schoustra
- Department of Otorhinolaryngology - Head and Neck Surgery , OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology - Head and Neck Surgery , OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands.,Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.,Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Meerie J L Steinbusch
- Department of Otorhinolaryngology - Head and Neck Surgery , OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands
| | - Kristel M Kasius
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery , OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, the Netherlands
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13
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Rodríguez Hermosa JL, Calle M, Guerassimova I, Fernández B, Montero VJ, Álvarez-Sala JL. Noninvasive electrical stimulation of oropharyngeal muscles in obstructive sleep apnea. Expert Rev Respir Med 2021; 15:1447-1460. [PMID: 34038311 DOI: 10.1080/17476348.2021.1935244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Continuous positive airway pressure (CPAP) therapy remains the standard treatment for obstructive sleep apnea. However, its proven effect is useless if the patient does not tolerate the treatment. The electrical stimulation approach has been investigated for several decades now and it seems that the implantable devices for invasive electrical stimulation of hypoglossal nerve are viewed as effective with some of them already approved for human use.Areas covered: in this review, we intent to summarize the existing records of noninvasive stimulation in sleep apnea to make the scientific community aware of the details before deciding on its future. We believe that this is a battle still to fight and more could be done bearing in mind the safety of this method.Expertopinion: noninvasive electrical stimulation has been left behind based on few, small and inconsistent studies using different stimulation parameters. These studies are difficult to compare and to draw conclusions.Electrical stimulation is a field for research in the treatment of obstructive sleep apnea, with many aspects still to be discovered, and which may become a therapeutic alternative to the use of CPAP in certain patients.
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Affiliation(s)
- Juan Luis Rodríguez Hermosa
- Pneumology Department. Hospital Clínico San Carlos. School of Medicine, Complutense University, Madrid, Spain
| | - Myriam Calle
- Pneumology Department. Hospital Clínico San Carlos. School of Medicine, Complutense University, Madrid, Spain
| | - Ina Guerassimova
- Pneumology Department. Hospital Clínico San Carlos. School of Medicine, Complutense University, Madrid, Spain
| | | | - Víctor Javier Montero
- Torytrans SL, Innovative and technological-based company, Almagro, Ciudad Real, Spain
| | - José Luis Álvarez-Sala
- Pneumology Department. Hospital Clínico San Carlos. School of Medicine, Complutense University, Madrid, Spain
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14
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Crossley JR, Wallerius K, Hoa M, Davidson B, Giurintano JP. Association Between Conflict of Interest and Published Position on Hypoglossal Nerve Stimulation for Sleep Apnea. Otolaryngol Head Neck Surg 2021; 165:375-380. [PMID: 33400633 DOI: 10.1177/0194599820982914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine if there is an association between authors' financial conflict of interest and published position on clinical use of hypoglossal nerve stimulation for obstructive sleep apnea. STUDY DESIGN Retrospective cross-sectional analysis. SETTING International roster of authors and articles analyzed. METHODS A Google Scholar search was performed for editorials and reviews citing the 2014 New England Journal of Medicine article on hypoglossal nerve stimulation for obstructive sleep apnea. Included articles were coded as favorable or neutral. Conflict of interest was recorded as declared by the authors in these articles and as independently searched in the Open Payments registry. RESULTS Sixteen articles from 45 independent authors were analyzed. Nine articles by authors were coded as favorable. Among authors of articles with favorable views, 16 (59%) had a financial conflict of interest with the manufacturer of the hypoglossal nerve stimulator device, as opposed to only 1 of 21 (5%) authors of neutral/unfavorable articles. When we included only authors to whom payments could be identified or excluded on Open Payments, 16 of 20 (80%; 95% CI, 62%-98%) authors of favorable articles had a financial conflict, while 1 of 10 (10%; 95% CI, 0%-29.6%) of neutral/unfavorable articles did (P = .004). CONCLUSION Our study demonstrates an association between published position on hypoglossal nerve stimulator use and financial conflict with the device manufacturer. Several undeclared conflicts were also found, suggesting a role for independent search for conflicts during the review process.
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Affiliation(s)
- Jason R Crossley
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Katherine Wallerius
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Hoa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Bruce Davidson
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jonathan P Giurintano
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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15
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Zhu Z, Hofauer B, Wirth M, Heiser C. Long-term changes of stimulation intensities in hypoglossal nerve stimulation. J Clin Sleep Med 2020; 16:1775-1780. [PMID: 32026804 DOI: 10.5664/jcsm.8320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Hypoglossal nerve stimulation (HNS) is a novel therapy in the treatment of obstructive sleep apnea. Previous studies have focused on the effectiveness of HNS, but there are no studies specifically investigating the long-term changes of the stimulation intensities in HNS. Increasing stimulation intensity requirements have been reported in the past in other peripheral nerve stimulation therapies. The aim of this study was to investigate the development of stimulation intensities over the observation period of 4 years. METHODS All patients who were implanted with an HNS system since December 2013 and maintained a bipolar configuration over the observation period were included. Sensation threshold (ST), functional threshold, the titrated stimulation intensity (SI), and the apnea-hypopnea index (AHI) were recorded. RESULTS A total of 82 patients were enrolled (sex: 69 men, 13 women, age: 60 ± 11 years, body mass index: 29. 8 ± 4.0 kg/m²). Two months after surgery, the median ST was 0.8 ± 0.5 V. During the observation period of 48 months, no significant change of ST was observed. The median ST was 1.0 ± 0.4 V (P = 0.93) at 48 months. Similar results were found for functional threshold and the titrated stimulation intensity. There was a significant reduction of the baseline median AHI when compared with the median AHI at 1, 12, 24, 36 and 48 months after surgery (P < 0.05). CONCLUSIONS The stimulation intensities in HNS show no significant changes over 4 years. Despite the constant stimulation intensity, AHI was significantly reduced. This indicates that the stimulation threshold of the hypoglossal nerve does not change over time with this therapy.
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Affiliation(s)
- Zhaojun Zhu
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Benedikt Hofauer
- Otorhinolaryngology/Head and Neck Surgery, University of Freiburg, Germany
| | - Markus Wirth
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Clemens Heiser
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
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16
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Meleca JB, Kominsky AH. The practicality of a two-incision surgical approach for hypoglossal nerve stimulator implantation. Am J Otolaryngol 2020; 41:102585. [PMID: 32521300 DOI: 10.1016/j.amjoto.2020.102585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Determine the feasibility of a two-incision surgical approach to hypoglossal nerve stimulator implantation based on anatomic considerations. METHODS Upper airway stimulation (UAS) using the Inspire system uses three implanted devices-the implantable pulse generator (IPG), stimulation lead and sensing chest wall lead. The traditional surgical approach requires three skin incisions located on the submandibular neck, anterosuperior chest wall and inferolateral chest wall. Our surgical team sought to determine the anatomic considerations of combining the two chest wall incisions into one. In order to minimize morbidity and reduce operative time, the chest wall sensing lead was placed posterolateral to the IPG site via the same incision. RESULTS Using an adult cadaver for anatomical analysis, access to the third and fourth intercostal spaces was made more difficult by the pectoralis major humeral head and upper arm. The intercostal space was narrower, the musculature along the anterior axillary line and anterior chest wall was devoid of the innermost intercostal muscle group found more laterally. Furthermore, there were much thinner external and internal intercostal muscle components as they transitioned to a membranous layer anteriorly in comparison to the inferolateral chest wall. CONCLUSION Lack of the innermost intercostal muscle and thinning of the external and internal intercostal muscles lateral to the IPG site leaves little barrier between the thoracic musculature and parietal pleural increasing the risk of complications such as pleurisy and pneumothorax. Given the anatomical findings, a two-incision surgical approach for UAS therapy is at higher risk for complications.
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Affiliation(s)
- Joseph B Meleca
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
| | - Alan H Kominsky
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA
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17
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Yu MS, Ibrahim B, Riley RW, Liu SYC. Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2020; 13:225-233. [PMID: 32683836 PMCID: PMC7435433 DOI: 10.21053/ceo.2020.00360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.
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Affiliation(s)
- Myeong Sang Yu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Badr Ibrahim
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Robert Wayne Riley
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
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18
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Abstract
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment selections, high-risk identification and targeted support, and comparative and multispecialty therapy studies.
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19
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Jenks CM, Yu JL, Schmitt KA, Schwab RJ, Thaler ER. Prospective Determination of Airway Response to Upper Airway Stimulation: A New Opportunity for Advanced Device Titration. Laryngoscope 2020; 131:218-223. [PMID: 32557705 DOI: 10.1002/lary.28758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Response to upper airway stimulation (UAS) is associated with the degree of airway opening during stimulation. UAS programming may affect this opening. The objective of this study was to examine airway changes in response to five different electrode configurations programmable within the Inspire UAS system. STUDY DESIGN Prospective single-arm cohort study. METHODS Subjects who underwent UAS implantation were recruited for a prospective single-arm cohort study during UAS device activation. Functional thresholds were recorded for all settings. Awake nasopharyngoscopy was performed to examine the retropalatal (RP) and retroglossal (RG) regions at rest and during activation with all settings at their functional thresholds. Cross-sectional measurements were made by two blinded reviewers and reported as percent change in airway size. RESULTS Sixteen patients were included. The standard setting (+-+) resulted in the greatest change in RP area in 43.8% of patients. An alternative setting resulted in greatest change in 56.2% of patients (--- and o-o in 18.8% each, -o- in 12.5%, and -+- in 6.3% of patients). Average response to all five settings was utilized to classify degree of palatoglossal coupling. Most patients had some enlargement (20%-70% change in RP area, 43.8%) or no enlargement (<20% change, 43.8%), whereas a minority of patients (12.5%) had marked enlargement (>70% change). RP and RG expansion were not correlated. CONCLUSION Degree of RP expansion varied among patients and settings. Although the standard setting resulted in greatest RP change in a plurality of patients, over half had a greater response to an alternative setting. Future studies should address whether choice of setting based on RP expansion results in improved outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:218-223, 2021.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason L Yu
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Division of Sleep Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Katherine A Schmitt
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Richard J Schwab
- Division of Sleep Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Erica R Thaler
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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20
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Kastoer C, Op de Beeck S, Dom M, Neirinckx T, Verbraecken J, Braem MJ, Van de Heyning PH, Nadjmi N, Vanderveken OM. Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement. Laryngoscope 2020; 130:E268-E274. [DOI: 10.1002/lary.28022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Chloé Kastoer
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Sara Op de Beeck
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Marc Dom
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
| | - Thérèse Neirinckx
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Department of PulmonologyAntwerp University Hospital Edegem, Antwerp Belgium
| | - Marc J. Braem
- Department of Special Care DentistryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Paul H. Van de Heyning
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Nasser Nadjmi
- Department of Oral and Cranio‐Maxillofacial SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology–Head and Neck SurgeryAntwerp University Hospital Edegem, Antwerp Belgium
- Multidisciplinary Sleep Disorders CentreAntwerp University Hospital Edegem, Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Wilrijk, Antwerp Belgium
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21
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Meleca JB, Kominsky AH. Reconfiguration of Upper Airway Stimulation Devices Utilizing Awake Endoscopy. Laryngoscope 2020; 130:2494-2498. [DOI: 10.1002/lary.28569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/19/2020] [Accepted: 01/25/2020] [Indexed: 01/14/2023]
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Obstructive Sleep Apnea: Emerging Treatments Targeting the Genioglossus Muscle. J Clin Med 2019; 8:jcm8101754. [PMID: 31652594 PMCID: PMC6832267 DOI: 10.3390/jcm8101754] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of upper airway obstruction caused by a loss of upper airway dilator muscle tone during sleep and an inadequate compensatory response by these muscles in the context of an anatomically compromised airway. The genioglossus (GG) is the main upper airway dilator muscle. Currently, continuous positive airway pressure is the first-line treatment for OSA. Nevertheless, problems related to poor adherence have been described in some groups of patients. In recent years, new OSA treatment strategies have been developed to improve GG function. (A) Hypoglossal nerve electrical stimulation leads to significant improvements in objective (apnea-hypopnea index, or AHI) and subjective measurements of OSA severity, but its invasive nature limits its application. (B) A recently introduced combination of drugs administered orally before bedtime reduces AHI and improves the responsiveness of the GG. (C) Finally, myofunctional therapy also decreases AHI, and it might be considered in combination with other treatments. Our objective is to review these therapies in order to advance current understanding of the prospects for alternative OSA treatments.
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23
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Development of a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. Eur Arch Otorhinolaryngol 2019; 276:901-909. [PMID: 30689040 DOI: 10.1007/s00405-019-05298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. METHOD This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation. RESULTS The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events. CONCLUSION The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.
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Successful upper airway stimulation therapy in an adult Down syndrome patient with severe obstructive sleep apnea. Sleep Breath 2018; 23:879-883. [PMID: 30430373 DOI: 10.1007/s11325-018-1752-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to report on the successful application of upper airway stimulation (UAS) therapy in an adult Down syndrome (DS) patient with severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) intolerance. METHODS Baseline polysomnography (PSG) in a 23-year-old male OSA patient (body mass index (BMI) 24.4 kg/m2) revealed an apnea/hypopnea index (AHI) of 61.5 events/h and oxygen desaturation index (ODI) of 39.7 events/h. Based on the clinical examination, PSG and drug-induced sleep endoscopy, the patient fulfilled the formal inclusion criteria for UAS therapy: AHI between 15 and 65 events/h, BMI < 32 kg/m2, and no complete concentric collapse at the level of the velopharynx. RESULTS Implantation of the hypoglossal nerve stimulator in the adult patient with DS resulted in a substantial subjective as well as objective improvement of OSA (63 to 81% decrease in AHI and 77% decrease in ODI), translating into an overall satisfactory outcome. CONCLUSION Research on the long-term effectiveness of UAS therapy in a larger group of patients with DS is needed. However, based on the available literature and our presented case, respiration-synchronized electrostimulation of the hypoglossal nerve using UAS therapy may have a potential value in well-selected OSA patients with DS who are non-compliant to CPAP therapy.
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Vanderveken OM. Drug-induced sleep endoscopy (DISE) as a guide towards upper airway behavior and treatment outcome: the quest for a vigorous standardization of DISE. Sleep Breath 2018; 22:897-899. [PMID: 30338440 DOI: 10.1007/s11325-018-1743-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital UZA, Wilrijkstraat 10, B-2650, Edegem, Belgium.
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The role of drug-induced sleep endoscopy: predicting and guiding upper airway surgery for adult OSA patients. Sleep Breath 2018; 22:925-931. [PMID: 30276710 DOI: 10.1007/s11325-018-1730-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/18/2018] [Accepted: 09/24/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common sleep disorder that can be corrected with upper airway surgery. Prior to surgery, drug-induced sleep endoscopy (DISE) is routinely used to evaluate obstruction sites and severity. Evidence suggests that the findings of DISE may relate to the final surgical outcome. Therefore, we evaluated the ability of drug-induced sleep endoscopy to predict the final effect of upper airway surgery and potentially to guide surgical treatment decision-making. METHODS A retrospective analysis was conducted on 85 adult patients with OSA (50 men with mean apnea-hypopnea index [AHI] 30 ± 15 events/h) who underwent DISE followed by tonsillectomy, uvulopalatopharyngoplasty (UPPP), or a combination of the two. Surgery outcome was evaluated at follow-up by polysomnography. Success response to surgery was defined as a postoperative value of the AHI< 20 events/h and more than 50% postoperative reduction of AHI. RESULTS Of the 85 patients evaluated, 48 (53%) were responders. DISE revealed significant differences between the two groups. Specifically, complete circumferential collapse at the velum and complete anterior-posterior collapse at the tongue base occurred at higher frequencies in nonresponders. In contrast, the presence of grade 3-4 tonsillar hypertrophy and anterior-posterior mild/partial collapse at the velum were positively associated with responders. CONCLUSIONS Our results suggest that DISE may help predict the final outcome of tonsillectomy, UPPP, or a combination of the two in adult patients with OSA. The use of DISE shows potential to guide treatment decisions for individual patients with OSA.
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Philip P, Heiser C, Bioulac S, Altena E, Penchet G, Cuny E, Hofauer B, Monteyrol PJ, Micoulaud-Franchi JA. Hypoglossal nerve stimulation on sleep and level of alertness in OSA: A preliminary study. Neurology 2018; 91:e615-e619. [PMID: 30021916 DOI: 10.1212/wnl.0000000000006001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To quantify the effect of hypoglossal nerve stimulation (HNS), a novel therapy for patients with obstructive sleep apnea, on objective level of alertness (measured with Maintenance of Wakefulness Test [MWT] values) and nocturnal sleep architecture. METHODS Ten male patients (mean age 52.0 ± 9.4 years; mean body mass index 28.8 ± 3.3 kg/m2) noncompliant to continuous positive airway pressure received HNS (Inspire therapy) and were prospectively evaluated at baseline and 6 months after HNS therapy. Polysomnographic parameters (sleep breathing and sleep architecture) and objective level of alertness (MWT) were measured. RESULTS The mean preimplantation apnea-hypopnea index of 46.7/h ± 12.2/h was reduced to 14.5/h ± 8.9/h at 6 months postimplantation (p < 0.001). The mean MWT latency improved from 25.0 ± 12.8 minutes at baseline to 36.8 ± 7.0 minutes after 6 months of treatment (p = 0.004). A reduction of N1% (11.8 ± 10.6 vs 4.2 ± 1.9, p = 0.04) was observed. The reduction in the duration of wake after sleep onset (WASO) was 71.4 ± 32.4 minutes vs 53.4 ± 13.5 minutes (p = 0.06) but was not significant. MWT latencies at 6 months were negatively correlated with the intensity of stimulation (r = -0.63, p = 0.05). Intensity of stimulation was positively correlated with WASO (r = 0.76, p = 0.01). CONCLUSION HNS improved the objective level of alertness and changed nocturnal sleep architecture. The level of neural stimulation determines the amount of nocturnal WASO and the level of objective level of alertness.
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Affiliation(s)
- Pierre Philip
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany.
| | - Clemens Heiser
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Stéphanie Bioulac
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Ellemarije Altena
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Guillame Penchet
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Emmanuel Cuny
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Benedikt Hofauer
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Pierre-Jean Monteyrol
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
| | - Jean-Arthur Micoulaud-Franchi
- From the Université de Bordeaux (P.P., S.B., E.A., J.-A.M.-F.), SANPSY, USR 3413, Bordeaux; CNRS-SANPSY (P.P., S.B., E.A., J.-A.M.-F.), USR 3413, Bordeaux; Clinique du Sommeil (P.P., S.B., P.-J.M., J.-A.M.-F.), CHU Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France; Service de Neuro-chirurgie (E.A., E.C.), CHU de Bordeaux, Place Amélie Raba-Léon, Bordeaux, France; and Department of Otolaryngology, Head and Neck Surgery (C.H., B.H.), Technical University of Munich, Klinikum Rechts der Isar, Hals-Nasen-Ohren-Klinik, Munich, Germany
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Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J, Pepin JL, Pevernagie D, Pizza F, Polo O, Riha R, Ryan S, Verbraecken J, McNicholas WT. Challenges and perspectives in obstructive sleep apnoea. Eur Respir J 2018; 52:13993003.02616-2017. [DOI: 10.1183/13993003.02616-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
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Kinesthetic stimulation for obstructive sleep apnea syndrome: An "on-off" proof of concept trial. Sci Rep 2018; 8:3092. [PMID: 29449609 PMCID: PMC5814419 DOI: 10.1038/s41598-018-21430-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/05/2018] [Indexed: 11/08/2022] Open
Abstract
Obstructive sleep apnea (OSA) occurs when the upper airway narrows or collapses due to the loss of upper airway muscle activation at sleep onset. This study investigated the effectiveness of triggered kinesthetic stimulation in patients with OSA. This proof-of-concept, open-label, multicenter prospective study was conducted on 24 patients with severe OSA. During a one night evaluation, kinesthetic stimulation was intermittently delivered in 30 minute periods. The duration of apneas and hypopneas during Stim on and Stim off periods were compared. Five hospital-based university centers in France participated. Sleep studies were evaluated by a single scorer at a core laboratory (CHU Grenoble). Results show that during the Stim on phases, statistically significant decreases in durations of apneas and hypopneas were observed in 56% and 46% of patients, respectively. Overall, 75% of patients showed an improvement in apneas or hypopneas durations. The mean reduction in durations for patients with a significant decrease was 4.86 seconds for apneas and 6.00 seconds for hypopneas. This proof of concept study is the first to identify kinesthetic stimulation as a potentially effective therapy for OSA. These data justify evaluation in a controlled study.
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