1
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Shah RR, Mahmoud AF, Dedhia RC, Thaler ER. Characteristic Pressure Waveforms Can Distinguish Airway Collapse Patterns in Sleep Apnea Patients: A Pilot Study. OTO Open 2024; 8:e161. [PMID: 38974173 PMCID: PMC11225081 DOI: 10.1002/oto2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To use pharyngeal pressure recordings to distinguish different upper airway collapse patterns in obstructive sleep apnea (OSA) patients, and to assess whether these pressure recordings correlate with candidacy assessment for hypoglossal nerve stimulator (HGNS) implantation. Study Design Prospective case series. Setting Single tertiary-quaternary care academic center. Methods Subjects with OSA prospectively underwent simultaneous drug-induced sleep endoscopy (DISE) and transnasal pharyngeal pressure recording with a pressure-transducing catheter. Pressure was recorded in the nasopharynx and oropharynx, and endoscopic collapse patterns were classified based on site, extent, and direction of collapse. Pressure recordings were classified categorically by waveform shape as well as numerically by inspiratory and expiratory amplitudes and slopes. Waveform shape, amplitude, and slope were then compared with the endoscopic findings. Results Twenty-five subjects with OSA were included. Nasopharyngeal waveform shape was associated with the extent of collapse at the level of the palate (P = .001). Oropharyngeal waveform shape was associated with anatomical site of collapse (P < .001) and direction of collapse (P = .019) below the level of the palate. Pressure amplitudes and slopes were also associated with the extent of collapse at various sites. Waveform shape was also associated with favorable collapse pattern on endoscopy for HGNS implantation (P = .043), as well as surgical candidacy for HGNS (P = .004). Conclusion Characteristic pharyngeal pressure waveforms are associated with different airway collapse patterns. Pharyngeal pressure is a promising adjunct to DISE in the sleep surgery candidacy evaluation.
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Affiliation(s)
- Ravi R. Shah
- Department of Otolaryngology–Head and Neck SurgeryHenry Ford Health + Michigan State UniversityDetroitMichiganUSA
| | | | - Raj C. Dedhia
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erica R. Thaler
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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2
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Van Loo D, Dieltjens M, Engelen S, Verbraecken J, Vanderveken OM. Hypoglossal Nerve Stimulation Therapy in a Belgian Cohort of Obstructive Sleep Apnea Patients. Life (Basel) 2024; 14:788. [PMID: 39063543 PMCID: PMC11278378 DOI: 10.3390/life14070788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Hypoglossal nerve stimulation (HGNS) has emerged as a widespread and innovative treatment option for selected moderate-to-severe obstructive sleep apnea (OSA) patients who cannot be treated effectively with traditional treatment modalities. In this observational cohort study, the objective and subjective outcomes of Belgian OSA patients treated with HGNS therapy were analyzed at 6 and 12 months post-implantation. Thirty-nine patients implanted with a respiration-synchronized HGNS device at the Antwerp University Hospital w ere included in this study. Patients underwent baseline in-laboratory polysomnography and a follow-up sleep study 6 and 12 months post-implantation. Questionnaires on patient experience and daytime sleepiness were filled out and data on objective therapy usage were collected. All 39 patients completed the 6-month follow-up and 21 patients (54%) completed the 12-month follow-up. Median AHI decreased from 33.8 [26.1;45.0] to 10.2 [4.8;16.4] at the 6-month follow-up, and to 9.6 [4.1;16.4] at the 12-month follow-up (p < 0.001). The surgical success rate, according to the Sher20 criteria, was 80% and 76% at the 6- and 12-month follow-ups, respectively. Median ESS improved from 12.0 [7.0;18.0] at baseline to 6.0 [2.5;11.0] at 6 months (p < 0.001) and to 6.5 [2.8;11.5] at 12 months (p = 0.012). Objective therapy usage was 7.4 [6.6;8.0] and 7.0 [5.9:8.2] h/night at the 6- and 12-month follow-ups, respectively. A high overall clinical effectiveness of HGNS therapy, as shown by a mean disease alleviation of 58%, was demonstrated at 12 months post-implantation. Overall, HGNS therapy using respiration-synchronized neurostimulation of the XII cranial nerve resulted in a significant improvement in both objective and subjective OSA outcomes, with a high level of patient satisfaction and high treatment adherence.
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Affiliation(s)
- Dorine Van Loo
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Marijke Dieltjens
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Sanne Engelen
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium;
- Research Group LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Olivier M. Vanderveken
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium;
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3
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Asarkar AA, Bui R, Calligas J, Gillespie MB, Nathan CAO. Where Does Hypoglossal Nerve Stimulator Implant Fit in the Surgical Management Algorithm of Obstructive Sleep Apnea? Laryngoscope 2024. [PMID: 38706430 DOI: 10.1002/lary.31486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Roger Bui
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - Jason Calligas
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, Louisiana, USA
| | - M Boyd Gillespie
- Department of Otolaryngology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, Louisiana, USA
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Hardin L. Hypoglossal nerve stimulation for adults with obstructive sleep apnea. JAAPA 2023; 36:24-29. [PMID: 37989167 DOI: 10.1097/01.jaa.0000991392.37494.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a common chronic condition in which upper airway collapse interferes with breathing during sleep, reducing sleep quality. Untreated OSA can impair a patient's health and quality of life. The recommended first-line treatment for OSA in adults is positive airway pressure, but difficulty tolerating this device limits adherence to treatment for many patients. Treatment with an implanted hypoglossal nerve stimulation (HNS) device is a relatively new second-line option for these patients, and is gaining more widespread use. Clinicians who treat OSA or provide other healthcare services to patients with HNS implants should be familiar with these devices. This article reviews HNS technology and relevant OSA pathophysiology, along with device candidacy criteria, efficacy, risks, and considerations related to use of other medical technologies for patients with HNS implants.
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Affiliation(s)
- Laura Hardin
- Laura Hardin practices in otolaryngology at Texas ENT Specialists in Houston, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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Corr F, Kilinç F, Oros J, Qasem LE, Al-Hilou A, Jussen D, Czabanka M, Quick-Weller J. Increased Body Mass Index Correlates with Less Favorable Postoperative Outcomes After Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A Retrospective Cohort Study. World Neurosurg 2023; 180:e210-e218. [PMID: 37714455 DOI: 10.1016/j.wneu.2023.09.027] [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: 07/24/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Obstructive sleep apnea is associated with high morbidity. Hypoglossal nerve stimulation (HNS) has become a novel (neuro-) surgical treatment strategy for obstructive sleep apnea, demonstrating good success rates. Beyond predefined inclusion and exclusion criteria, no precise data are available, enabling individual preoperative risk assessment. To improve preoperative risk stratification, this study analyzed individual patient factors that affect outcomes of HNS. METHODS Fourteen patients treated with unilateral HNS were analyzed retrospectively. Assessed risk factors included: hypertension, diabetes mellitus, depression, smoking, alcohol consumption, body mass index (BMI), and disease duration. Treatment success was defined as a reduction in the postoperative apnea-hypopnea index (AHI) to ≤20 events/hour, with a relative reduction of at least 50% compared to baseline. RESULTS A significant reduction in the postoperative apnea-hypopnea index was observed in all patients (P < 0.0001). BMI correlated significantly with postoperative AHI scores (95% confidence interval, 0.1519-0.8974; P = 0.018). Significant treatment success was observed in 50% of patients. Compared with the "Excellent Responder group," the "Responder group" demonstrated a significantly higher BMI (95% confidence interval, 1.174-6.226; P = 0.0078). Diabetes, hypertension, disease duration, smoking, depression, and alcohol consumption were not significantly associated with AHI reduction. CONCLUSIONS Our findings suggest that BMI may be an independent risk factor for the response to HNS, with patients who had less benefit from therapy having significantly higher BMI than "Excellent Responders." Therefore, carefully selecting patients is crucial in obtaining optimal outcomes with HNS therapy, especially those with a high BMI.
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Affiliation(s)
- Felix Corr
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany.
| | - Fatma Kilinç
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Jan Oros
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Lina-Elisabeth Qasem
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Ali Al-Hilou
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Jussen
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Johanna Quick-Weller
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany
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6
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Kent D, Huyett P, Yu P, Roy A, Mehra R, Rundo JV, Stahl S, Manchanda S. Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography vs home-based efficacy sleep testing. J Clin Sleep Med 2023; 19:1905-1912. [PMID: 37421320 PMCID: PMC10620657 DOI: 10.5664/jcsm.10712] [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: 03/27/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES We conducted this study to evaluate whether laboratory or home-based hypoglossal nerve stimulation (HNS) management would have equivalent objective and subjective obstructive sleep apnea outcomes 6 months after activation. METHODS Patients undergoing standard-of-care HNS implantation were randomly assigned in a prospective, multicenter clinical trial to either a 3-month postactivation in-laboratory titration polysomnography (tPSG) or an efficacy home sleep study (eHST) with tPSG by exception for eHST nonresponders at 5 months. Both groups underwent an eHST 6 months postactivation. RESULTS Sixty patients were randomly assigned. Patients experienced equivalent decreases in the apnea-hypopnea index (mean difference: -0.01 events/h [-8.75, 8.74]) across both groups with HNS; the selection of tPSG or eHST did not associate with therapy response rates (tPSG vs eHST: 63.2% vs 59.1%). The Epworth Sleepiness Scale (median of differences: 1 [-1, 3]) and device usage (median of differences: 0.0 hours [-1.3, 1.3]) outcomes were similar but did not meet a priori statistical equivalence criteria. CONCLUSIONS This prospective, multicenter, randomized clinical trial demonstrated that patients undergoing HNS implantation experienced statistically equivalent improvements in objective obstructive sleep apnea outcomes and similar improvements in daytime sleepiness regardless of whether they underwent tPSG. HNS titration with tPSG may not be required for all postoperative patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Inspire Home Study: Utilization of Home Monitoring During Therapy Optimization in Patients With an Inspire Upper Airway Stimulation System (Comparison of Home Sleep Testing vs. In-lab Polysomnography Testing) (HOME); URL: https://clinicaltrials.gov/ct2/show/NCT04416542; Identifier: NCT04416542. CITATION Kent D, Huyett P, Yu P, et al. Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography vs home-based efficacy sleep testing. J Clin Sleep Med. 2023;19(11):1905-1912.
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Affiliation(s)
- David Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts
| | - Phoebe Yu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts
| | - Asim Roy
- Ohio Sleep Medicine Institute, Columbus, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute; Respiratory Institute; Cardiovascular and Metabolic Sciences, Lerner Research Institute; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jessica Vensel Rundo
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephanie Stahl
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, and Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shalini Manchanda
- Department of Otolaryngology-Head and Neck Surgery, and Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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7
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Lowery MM, Rundo JV, Walia HK, Shah V. Personalized multimodal management for severe obstructive sleep apnea in a patient intolerant of positive airway pressure with hypoglossal nerve stimulator and mandibular advancement device. J Clin Sleep Med 2023; 19:403-408. [PMID: 36117433 PMCID: PMC9892739 DOI: 10.5664/jcsm.10296] [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: 05/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Treatment of moderate to severe obstructive sleep apnea poses clinical challenges in persons with intolerance or inadequate response to traditional treatment modalities, including positive airway pressure and mandibular advancement devices. Hypoglossal nerve stimulation is a new treatment option, but few management guidelines exist when it is intolerable or ineffective. Combining several treatment modalities has been an effective strategy for improving symptoms, tolerance, and efficacy. We describe a patient intolerant to positive airway pressure therapy who had continued sleepiness, morning headaches, and snoring with a mandibular advancement device. He underwent hypoglossal nerve stimulation implantation but was intolerant of the voltages required to adequately control his obstructive sleep apnea. Multimodal management with hypoglossal nerve stimulation, mandibular advancement device, and positional therapy was successfully implemented to improve sleepiness, nocturnal symptoms, and the apnea-hypopnea index. This case highlights the personalization and adaptability of combination therapy to suit patient needs while effectively controlling obstructive sleep apnea. CITATION Lowery MM, Rundo JV, Walia HK, Shah V. Personalized multimodal management for severe obstructive sleep apnea in a patient intolerant of positive airway pressure with hypoglossal nerve stimulator and mandibular advancement device. J Clin Sleep Med. 2023;19(2):403-408.
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Affiliation(s)
- Megan M. Lowery
- Pulmonary, Critical Care and Sleep, University of Florida, Gainesville, Florida
| | - Jessica Vensel Rundo
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Harneet K. Walia
- Sleep Medicine, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Vaishal Shah
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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8
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Hsieh YH, Schell AE, Yeh E, Strohl MP, Curado TF, Strohl KP. Neurostimulation in the Management of Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Despite extensive research, there is currently no approved drug for obstructive sleep apnea (OSA) treatment. OSA is a heterogeneous condition that involves multiple dominating pathophysiological traits. Drug development in this field needs to address both pathophysiological mechanisms and associated comorbid conditions in order to meet requirements for long-term therapy in OSA. Several drug candidates have been proposed and ongoing phase II trials that target various forms of sleep-disordered breathing have been initiated. The field is moving toward tailored therapeutic approaches in patients with OSA.
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10
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Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Chirurgische Therapieverfahren“. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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11
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Dynamics of Circulating CD14/CD16 Monocyte Subsets in Obstructive Sleep Apnea Syndrome Patients upon Hypoglossal Nerve Stimulation. Biomedicines 2022; 10:biomedicines10081925. [PMID: 36009474 PMCID: PMC9405940 DOI: 10.3390/biomedicines10081925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is a widespread respiratory disease that is associated with recurrent breathing intermissions at night. The corresponding oxidative stress triggers a low-grade systemic inflammation which leads to alterations of different immune cells in the peripheral blood. The current standard treatment for OSAS is continuous positive airway pressure (CPAP), whereas hypoglossal nerve stimulation (HNS) has been established as a second-line treatment option for CPAP failure. The aim of the study was to investigate the influence of HNS for OSAS patients on the distribution and differentiation of circulating monocyte subsets in connection with the clinical parameters. Materials and Methods: Therefore, a detailed analysis of the distribution of CD14/CD16 characterized monocyte subsets in the peripheral blood of OSAS patients before and after HNS therapy was performed by flow cytometry. Furthermore, values of BMI (body mass index), ODI (oxygen desaturation index), and ESS (Epworth Sleepiness Scale) were measured. Results: These OSAS patients significantly improved AHI and ESS scores under HNS. In addition, HNS revealed the potential to ensure normal distributions of blood monocyte subsets and even improved the monocyte dynamics in selected OSAS patients, but there were no significant correlations with AHI, ODI, HNS usage, and daytime sleepiness. Conclusions: We conclude that HNS-related positive effects on the oxygenation of the peripheral blood as well as affect the distribution of circulating monocyte subsets, but clinical OSAS correlations are missing. Far more individual clinical, cellular and molecular factors are involved in this sensitive and complex regulatory network and have to be elucidated in further studies.
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12
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Gambino F, Zammuto MM, Virzì A, Conti G, Bonsignore MR. Treatment options in obstructive sleep apnea. Intern Emerg Med 2022; 17:971-978. [PMID: 35460431 PMCID: PMC9135849 DOI: 10.1007/s11739-022-02983-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Treatment of OSA with CPAP is currently the recommended treatment and has the greatest evidence of efficacy on AHI, symptoms and comorbidities. Symptomatic patients with moderate-severe OSA generally have good adherence to CPAP therapy, while those with mild OSA, female, young and generally paucisymptomatic, have lower CPAP adherence, especially in the medium and long term. The recent identification of different clinical and pathophysiological phenotypes of OSA has paved the way for alternative treatments to CPAP, leading to an increasingly personalized therapy. Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients. Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence. The purpose of this review is to compare the efficacy, adherence and costs of various therapeutic options for OSA patients in the light of recent evidence and to provide useful guidance for specialists.
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Affiliation(s)
- Francesco Gambino
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Marta Maria Zammuto
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Alessandro Virzì
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Giosafat Conti
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Maria Rosaria Bonsignore
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy.
- PROMISE Department, University of Palermo, Palermo, Italy.
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13
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Friedman NR, Green KK. Upper Airway Stimulation for Children With Down Syndrome and Obstructive Sleep Apnea-A New Frontier. JAMA Otolaryngol Head Neck Surg 2022; 148:529-530. [PMID: 35446405 DOI: 10.1001/jamaoto.2022.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora.,Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora
| | - Katherine K Green
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora
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14
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Soose RJ, Araujo M, Faber K, Roy A, Lee K, Ni Q, Srivastava J, Strollo PJ. Cluster analysis of upper airway stimulation adherence patterns and implications on clinical care. Sleep 2022; 45:6542728. [DOI: 10.1093/sleep/zsac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/29/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study Objectives
Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with continuous positive airway pressure (CPAP) intolerance. While overall adherence is high, some patients have suboptimal adherence, which limits efficacy. Our goal was to identify therapy usage patterns during the first 3 months of therapy to enable targeted strategies for improved adherence.
Methods
Therapy data was retrieved from 2098 patients for three months after device activation. Data included mean and standard deviation (SD) of hours of use, therapy pauses, hours from midnight the therapy was turned ON and OFF, percentage of missing days, and stimulation amplitude. Cluster analysis was performed using Gaussian mixture models that categorized patients into six main groups.
Results
The six groups and their prevalence can be summarized as Cluster 1A: Excellent Use (34%); Cluster 1B: Excellent Use with variable timing (23%); Cluster 2A: Good Use with missing days and late therapy ON (16%), Cluster 2B: Good Use with missing days, late therapy ON, and early therapy OFF (12%); Cluster 3A: Variable Use with frequent missing days (8%); Cluster 3B: Variable Use with frequent pauses (7%). Most patients (85%) are excellent or good users with mean therapy use >6 hours per night.
Conclusions
Cluster analysis of early UAS usage patterns identified six distinct groups that may enable personalized interventions for improved long-term management. Differentiation of the patient clusters may have clinical implications with regard to sleep hygiene education, therapy discomfort, comorbid insomnia, and other conditions that impact adherence.
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Affiliation(s)
- Ryan J Soose
- UPMC Department of Otolaryngology, University of Pittsburgh , Pittsburgh, PA, USA
| | - Matheus Araujo
- Department of Computer Science and Engineering, University of Minnesota , Minneapolis, MN , USA
| | - Kevin Faber
- Sanford Health, Sleep Medicine , Fargo, ND , USA
| | - Asim Roy
- Ohio Sleep Medicine Institute , Columbus, OH , USA
| | - Kent Lee
- Inspire Medical Systems , Golden Valley, MN , USA
| | - Quan Ni
- Inspire Medical Systems , Golden Valley, MN , USA
| | - Jaideep Srivastava
- Department of Computer Science and Engineering, University of Minnesota , Minneapolis, MN , USA
| | - Patrick J Strollo
- UPMC Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, PA, USA
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15
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Dedhia RC. The hidden magic of hypoglossal nerve stimulation therapy: organizing the sleep surgery research community. J Clin Sleep Med 2021; 17:2353-2354. [PMID: 34669573 DOI: 10.5664/jcsm.9720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Raj C Dedhia
- Department of Otorhinolaryngology and Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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