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Dhanda Patil R, Suurna MV, Steffen A, Soose R, Coxe J, Chan T, Ishman SL. Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation. OTO Open 2024; 8:e134. [PMID: 38646184 PMCID: PMC11032643 DOI: 10.1002/oto2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024] Open
Abstract
Objective In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes. Study Design Observational. Setting Multicenter registry. Methods We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction. Results No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Among all patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery. Conclusion In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnatiOhioUSA
- Surgical ServicesCincinnati Veterans Affairs Medical CenterCincinnatiOhioUSA
| | - Maria V. Suurna
- Department of Otolaryngology–Head and Neck SurgeryUniversity of MiamiMiamiFloridaUSA
| | - Armin Steffen
- Department of OtorhinolaryngologyUniversity of LubeckLubeckGermany
| | - Ryan Soose
- Department of OtolaryngologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - James Coxe
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnatiOhioUSA
| | - Teresa Chan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Texas‐Southwestern Medical CenterDallasTexasUSA
| | - Stacey L. Ishman
- Division of Otolaryngology–Head and Neck SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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2
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Eagle SR, Puccio AM, Agoston DV, Soose R, Mancinelli M, Nwafo R, McIntyre P, Agnone A, Tollefson S, Collins M, Kontos AP, Schneider W, Okonkwo DO. Evaluating Targeted Therapeutic Response With Predictive Blood-Based Biomarkers in Patients With Chronic Mild Traumatic Brain Injury. Neurotrauma Rep 2023; 4:404-409. [PMID: 37360545 PMCID: PMC10288300 DOI: 10.1089/neur.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Chronic consequences of mild traumatic brain injury (mTBI) are heterogeneous, but may be treatable with targeted medical and rehabilitation interventions. A biological signature for the likelihood of response to therapy (i.e., "predictive" biomarkers) would empower personalized medicine post-mTBI. The purpose of this study was to correlate pre-intervention blood biomarker levels and the likelihood of response to targeted interventions for patients with chronic issues attributable to mTBI. Patients with chronic symptoms and/or disorders secondary to mTBI >3 months previous (104 days to 15 years; n = 74) were enrolled. Participants completed pre-intervention assessments of symptom burden, comprehensive clinical evaluation, and blood-based biomarker measurements. Multi-domain targeted interventions for specific symptoms and impairments across a 6-month treatment period were prescribed. Participants completed a follow-up testing after the treatment period. An all-possible model's backward logistic regression was built to identify predictors of improvement in relation to blood biomarker levels before intervention. The minimum clinically important difference (MCID) of the change score (post-intervention subtracted from pre-intervention) for the Post-Concussion Symptom Scale (PCSS) to identify treatment responders from non-responders was the primary outcome. The MCID for total PCSS score was 10. The model to predict change in PCSS score over the 6-month intervention was significant (R2 = 0.09; p = 0.01) and identified ubiquitin C-terminal hydrolase L1 (odds ratio [OR] = 2.53; 95% confidence interval [CI], 1.18-5.46; p = 0.02) and hyperphosphorylated tau (p-tau; OR = 0.70; 95% CI, 0.51-0.96; p = 0.03) as significant predictors of symptom improvement beyond the PCSS MCID. In this cohort of chronic TBI subjects, blood biomarkers before rehabilitation intervention predicted the likelihood of response to targeted therapy for chronic disorders post-TBI.
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Affiliation(s)
- Shawn R. Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Denes V. Agoston
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Mancinelli
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel Nwafo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peyton McIntyre
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Allison Agnone
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Savannah Tollefson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Collins
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Walter Schneider
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ramprasad V, Menzl A, Makey L, Chio E, Steffen A, Maurer J, Heiser C, Lee K, Soose R. 0749 Does Prior Nasal Surgery Impact Outcomes of Upper Airway Stimulation Therapy for OSA? Sleep 2022. [DOI: 10.1093/sleep/zsac079.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Nasal airway obstruction can play an important role in pathogenesis and treatment of obstructive sleep apnea (OSA). Surgery for nasal obstruction can improve patient-reported OSA outcomes, including snoring and daytime sleepiness, as well as adherence and pressure requirements with continuous positive airway pressure (CPAP) therapy. The aim of this study was to examine whether previous nasal surgery was associated with UAS treatment efficacy.
Methods
From the ADHERE Registry, propensity score matching generated a cohort of UAS patients with prior nasal surgery including septoplasty, turbinate reduction, polyp removal (NS) and a comparable cohort of UAS patients without prior nasal surgery (WNS). Patients were matched based on demographic variables including pre-operative oral appliance use, prior CPAP use, gender, age, baseline apnea hypopnea index (AHI) and baseline Epworth Sleepiness Score (ESS). Data included demographic variables, therapy outcome measures including AHI, ESS, therapy use, and responder rate. Student’s t-test was used to compare normally distributed numeric data and Fisher’s exact test to compare categorical data. One sided t-tests with non-inferiority margin of 7.5 events/hr for AHI, 2 points for ESS, and 0.5 hr/night for Therapy Use were performed to determine non-inferiority.
Results
The ADHERE dataset from October 2021 included 169 patients from each cohort were matched for comparison. Reduction in AHI was 21.01 ±17.94 in WNS cohort and 18.39 ± 16.4 after UAS (p=0.162) in NS cohort. Reduction in ESS in WNS cohort was 4.85 ± 4.98 and 4.48 ±5.83 (p=0.528) in NS cohort. Therapy use was similar, 5.67 ± 1.95 in WNS and 5.97 ± 2.06 in NS (p=0.181). Responder rate was also similar in WNS (64.5%) and NS (62.1%) (p=0.735).
Conclusion
Retrospective analysis of UAS patients with vs without prior nasal surgery did not identify differences in UAS therapy outcomes or adherence. Furthermore, outcomes for patients with nasal surgery were non-inferior to those without. Future prospective studies of UAS candidates with nasal airway obstruction may better determine the role of adjunctive nasal surgery in this population.
Support (If Any)
Inspire Medical Systems
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Affiliation(s)
- Vaibhav Ramprasad
- University of Pittsburgh Medical Center Department of Otolaryngology
| | | | | | - Eugene Chio
- Ohio State University Department of Otolaryngology
| | | | | | | | | | - Ryan Soose
- University of Pittsburgh Department of Otolaryngology
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4
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Soose R, Araujo M, Faber K, Roy A, Lee K, Ni Q, Srivastava J, Strollo P. 0772 Clusters of Upper Airway Stimulation Adherence Patterns in the First 90 Days. Sleep 2022. [DOI: 10.1093/sleep/zsac079.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with CPAP intolerance. While overall adherence is high, some patients have suboptimal adherence to UAS, which limits effectiveness. Our goal was to identify UAS therapy usage patterns during the first three months of therapy that affect adherence.
Methods
We retrieved anonymized UAS therapy usage data from 2,091 individuals stored in a cloud-based monitoring system during the first three months after device activation. We aggregated adherence data including mean and standard deviation (SD) of nightly hours of use, therapy pauses, hours from midnight when the therapy was turned ON and OFF, and percentage of missing days. We computed the difference of the stimulation amplitude between the first and last day. We performed cluster analysis with Gaussian mixture models and computed the centroids of each cluster highlighting their main differences.
Results
We identified six distinct clusters of UAS usage patterns. Clusters 1A (34% of the total cohort) and 1B (23%) had excellent therapy usage with 7.23h and 7.14h on days of use, respectively; with 1B distinguished by increased night-to-night variability. Clusters 2A (16%) and 2B (12%) had good mean therapy use of 6.63h and 6.21h, respectively, but their usage patterns were distinguished by a higher percentage of missing days (8% missing days in 2A and 23% in 2B) and less favorable therapy timing with an average therapy ON time after midnight. Clusters 3A (8%) and 3B (7%) were characterized by the lowest nightly use at 6.16h and 5.50h, respectively, and the highest night-to-night variability. 3A was further distinguished by the highest percentage of missing days (34%) while 3B was characterized by the frequent therapy pauses (mean 4.1 pauses per night) and the least increase in stimulation amplitude across the first 90 days.
Conclusion
Cluster analysis of UAS usage patterns identified six distinct groups that may enable custom interventions for improved long-term management. Differentiation of these groups may have clinical implications on conditions (e.g. therapy discomfort, comorbid insomnia, poor sleep hygiene) that impact adherence.
Support (If Any)
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5
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Suurna MV, Steffen A, Boon M, Chio E, Copper M, Patil RD, Green K, Hanson R, Heiser C, Huntley C, Kent D, Larsen C, Manchanda S, Maurer JT, Soose R, de Vries N, Walia HK, Thaler E. Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update. Laryngoscope 2021; 131:2616-2624. [PMID: 34626128 DOI: 10.1002/lary.29755] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 06/06/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. STUDY DESIGN Prospective observational study. METHODS ADHERE captures UAS outcomes including apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1-year period. BMI ≤32 kg/m2 (BMI32 ) and 32 < BMI ≤35 kg/m2 (BMI35 ) group outcomes were examined. RESULTS One thousand eight hundred forty-nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (-20.9, P < .0001) and ESS (- 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 versus 5.2 ± 2.2 hr/day in BMI35 (P = .028). CONCLUSIONS Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2616-2624, 2021.
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Affiliation(s)
- Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, U.S.A
| | - Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Maurits Boon
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - Eugene Chio
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A
| | - Marcel Copper
- Department of Otolaryngology-Head and Neck Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Reena Dhanda Patil
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Department of Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A
| | - Katherine Green
- Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A
| | - Ronald Hanson
- Otolaryngology, St. Cloud Ear, Nose, Throat Clinic, St. Cloud, Minnesota, U.S.A
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Colin Huntley
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Christopher Larsen
- Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Andover, Kansas, U.S.A
| | - Shalini Manchanda
- Section of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, U.S.A
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ryan Soose
- Division of Sleep Surgery, Department of Otolaryngology, Pittsburgh School of Medicine, UPMC Mercy, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Nico de Vries
- Department of Ear, Nose and Throat, OLVG, Department of Oral Kinesiology, ACTA Amsterdam, Amsterdam, The Netherlands
| | - Harneet K Walia
- Cleveland Clinic, Sleep Disorders Center, Neurological Institute, Cleveland, Ohio, U.S.A
| | - Erica Thaler
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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6
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Suurna MV, Jacobowitz O, Chang J, Koutsourelakis I, Smith D, Alkan U, D'Agostino M, Boon M, Heiser C, Hoff P, Huntley C, Kent D, Kominsky A, Lewis R, Maurer JT, Ravesloot M, Soose R, Steffen A, Weaver E, Williams AM, Woodson T, Yaremchuk K, Ishman SL. Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum. J Clin Sleep Med 2021; 17:2477-2487. [PMID: 34279214 DOI: 10.5664/jcsm.9542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypoglossal nerve stimulation (HGNS) has evolved as a novel and effective therapy for patients with moderate-to-severe obstructive sleep apnea (OSA). Despite positive published outcomes of HGNS, there exist uncertainties regarding proper patient selection, surgical technique, and the reporting of outcomes and individual factors that impact therapy effectiveness. According to current guidelines, this therapy is indicated for select patients, and recommendations are based on the Stimulation Therapy for Apnea Reduction (STAR) trial. Ongoing research and physician experiences continuously improve methods to optimize the therapy. An understanding of the way in which airway anatomy, OSA phenotypes, individual health status, psychological conditions and comorbid sleep disorders influence the effectiveness of HGNS is essential to improve outcomes and expand therapy indications. This manuscript presents discussions on current evidence, future directions, and research gaps for HGNS therapy from the 10th International Surgical Sleep Society expert research panel.
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Affiliation(s)
- Maria V Suurna
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | | | - Jolie Chang
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA
| | | | - David Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
| | - Uri Alkan
- Department of Otorhinolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark D'Agostino
- Southern New England Ear, Nose, Throat and Facial Plastic Surgery Group and Middlesex Hospital, Middletown, CT
| | - Maurits Boon
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Paul Hoff
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Colin Huntley
- Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Kominsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Lewis
- Perth Head & Neck Surgery, Hollywood Medical Centre, Nedlands, Australia
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Ryan Soose
- Division of Sleep Surgery, Department of Otolaryngology, Pittsburgh School of Medicine, UPMC Mercy, University of Pittsburgh, Pittsburgh, PA
| | - Armin Steffen
- Department of otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Edward Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington; Surgery Service, Seattle Veterans Affairs Medical Center; Harborview Medical Center, Seattle, WA
| | - Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Tucker Woodson
- Division of Sleep Medicine and Sleep Surgery, Department of Otolaryngology and Human Communication of Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen Yaremchuk
- Department of Otolaryngology - Head & Neck Surgery of Henry Ford Health System, Detroit, MI
| | - Stacey L Ishman
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology - Head and Neck Surgery of University of Cincinnati College of Medicine, Cincinnati, OH
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7
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Ruffin AT, Cillo AR, Tabib T, Liu A, Onkar S, Kunning SR, Lampenfeld C, Atiya HI, Abecassis I, Kürten CHL, Qi Z, Soose R, Duvvuri U, Kim S, Oesterrich S, Lafyatis R, Coffman LG, Ferris RL, Vignali DAA, Bruno TC. B cell signatures and tertiary lymphoid structures contribute to outcome in head and neck squamous cell carcinoma. Nat Commun 2021; 12:3349. [PMID: 34099645 PMCID: PMC8184766 DOI: 10.1038/s41467-021-23355-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/21/2021] [Indexed: 01/06/2023] Open
Abstract
Current immunotherapy paradigms aim to reinvigorate CD8+ T cells, but the contribution of humoral immunity to antitumor immunity remains understudied. Here, we demonstrate that in head and neck squamous cell carcinoma (HNSCC) caused by human papillomavirus infection (HPV+), patients have transcriptional signatures of germinal center (GC) tumor infiltrating B cells (TIL-Bs) and spatial organization of immune cells consistent with tertiary lymphoid structures (TLS) with GCs, both of which correlate with favorable outcome. GC TIL-Bs in HPV+ HNSCC are characterized by distinct waves of gene expression consistent with dark zone, light zone and a transitional state of GC B cells. Semaphorin 4a expression is enhanced on GC TIL-Bs present in TLS of HPV+ HNSCC and during the differentiation of TIL-Bs. Our study suggests that therapeutics to enhance TIL-B responses in HNSCC should be prioritized in future studies to determine if they can complement current T cell mediated immunotherapies.
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Affiliation(s)
- Ayana T Ruffin
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Program in Microbiology and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | - Anthony R Cillo
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | - Tracy Tabib
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angen Liu
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sayali Onkar
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Program in Microbiology and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | - Sheryl R Kunning
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | - Caleb Lampenfeld
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | - Huda I Atiya
- Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Hematology and Oncology, Department of Medicine, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Irina Abecassis
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Zengbiao Qi
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Umamaheswar Duvvuri
- Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steffi Oesterrich
- Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Lafyatis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lan G Coffman
- Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Hematology and Oncology, Department of Medicine, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert L Ferris
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Dario A A Vignali
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Tullia C Bruno
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA.
- Tumor Microenvironment Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Hillman Cancer Center, Pittsburgh, PA, USA.
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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8
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Krieger D, Shepard P, Soose R, Puccio AM, Beers S, Schneider W, Kontos AP, Collins MW, Okonkwo DO. Symptom-Dependent Changes in MEG-Derived Neuroelectric Brain Activity in Traumatic Brain Injury Patients with Chronic Symptoms. Med Sci (Basel) 2021; 9:medsci9020020. [PMID: 33806153 PMCID: PMC8103254 DOI: 10.3390/medsci9020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
Neuroelectric measures derived from human magnetoencephalographic (MEG) recordings hold promise as aides to diagnosis and treatment monitoring and targeting for chronic sequelae of traumatic brain injury (TBI). This study tests novel MEG-derived regional brain measures of tonic neuroelectric activation for long-term test-retest reliability and sensitivity to symptoms. Resting state MEG recordings were obtained from a normative cohort, Cambridge Centre for Ageing and Neuroscience (CamCAN), baseline: n = 619; mean 16-month follow-up: n = 253) and a chronic symptomatic TBI cohort, Targeted Evaluation, Action and Monitoring of Traumatic Brain Injury (TEAM-TBI), baseline: n = 64; mean 6-month follow-up: n = 39). For the CamCAN cohort, MEG-derived neuroelectric measures showed good long-term test-retest reliability for most of the 103 automatically identified stereotypic regions. The TEAM-TBI cohort was screened for depression, somatization, and anxiety with the Brief Symptom Inventory and for insomnia with the Insomnia Severity Index. Linear classifiers constructed from the 103 regional measures from each TEAM-TBI cohort member distinguished those with and without each symptom, with p < 0.01 for each-i.e., the tonic regional neuroelectric measures of activation are sensitive to the presence/absence of these symptoms. The novel regional MEG-derived neuroelectric measures obtained and tested in this study demonstrate the necessary and sufficient properties to be clinically useful-i.e., good test-retest reliability, sensitivity to symptoms in each individual, and obtainable using automatic processing without human judgement or intervention.
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Affiliation(s)
- Don Krieger
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15232, USA; (A.M.P.); (D.O.O.)
- Correspondence:
| | - Paul Shepard
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15232, USA; (A.M.P.); (D.O.O.)
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Walter Schneider
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Anthony P. Kontos
- Department of Sports Medicine, University of Pittsburgh, Pittsburgh, PA 15232, USA; (A.P.K.); (M.W.C.)
| | - Michael W. Collins
- Department of Sports Medicine, University of Pittsburgh, Pittsburgh, PA 15232, USA; (A.P.K.); (M.W.C.)
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15232, USA; (A.M.P.); (D.O.O.)
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9
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Eagle SR, Kontos AP, Collins MW, Mucha A, Holland CL, Edelman K, Benso S, Schneider W, Soose R, Okonkwo DO. Targeted Intervention Improves Symptoms and Impairments in Patients With Mild Traumatic Brain Injury With Chronic Symptom: A Prospective, Multiple Interventional Research Trial. J Spec Oper Med 2021; 21:61-66. [PMID: 34105123 DOI: 10.55460/aey2-8nri] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) and its potential long-term consequences is a primary concern for the US military. The purpose of the study is to evaluate if participants improved in anxiety/mood symptoms, sleep quality, and vestibular/ocular symptoms following a 6-month active intervention, and to explore the effect of targeted treatment for those with specific symptoms/impairments (e.g., psychological, sleep, ocular, vestibular). MATERIALS AND METHODS A multidisciplinary clinical team adjudicated participants (n=72, 35.8±8.6 years old, 19% female) to have one of the following primary clinical trajectories: psychological (PSYCH; n=34), sleep (SLEEP; n=25) and vestibular/ocular (VESTIB/OCULAR; n=18). Participants returned for follow-up assessment 6 months later. Assessments included the Post-Concussion Symptom Scale [PCSS], Generalized Anxiety Disorder-7 [GAD-7], Pittsburgh Sleep Quality Index [PSQI], and Dizziness Handicap Inventory [DHI]. Change in concussion symptoms and primary outcome for the given trajectory (i.e., PSYCH=GAD-7, SLEEP=PSQI, VESTIB/OCULAR=DHI) was assessed. RESULTS Following the 6-month intervention, participants reduced PCSS Score (-14.5±2.4; p<.001; η2=0.34), GAD-7 (-3.1±0.5; p<.001; η2=0.34), PSQI (-2.7±0.5; p<.001; η2=0.34) and DHI (-9.2±2.0; p<.001; η2=0.23). PSYCH (n=34) reduced PCSS score (-17.9±3.6; p<.001; η2=0.45) and GAD-7 (-3.1±0.7; p<.001; η2=0.38). SLEEP (n=25) reduced PCSS score (-8.8±4.4; p=.06; η2=0.15) and PSQI (-3.6±0.9; p<.001; η2=0.45) scores. VESTIB/OCULAR (n=18) reduced PCSS score (-16.7±4.8; p=.03; η2=0.45), and DHI (-15.7±5.5; p=.012; η2=0.35). CONCLUSIONS Large effects were observed for concussion, anxiety, sleep, and dizziness symptom reduction over 6-month treatment. Each primary outcome demonstrated a larger treatment effect for the given trajectory than the overall sample, indicating that targeted treatment can reduce symptom burden in patients with mTBI with chronic symptoms.
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10
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Ruffin AT, Cillo AR, Tabib T, Liu A, Onkar S, Kunning S, Lampfield C, Abecassis I, Qi Z, Soose R, Duvvuri U, Kim S, Lafyatis R, Ferris RL, Vignali D, Bruno TC. Distinct B cell signatures and tertiary lymphoid structures are driven by two etiol-ogies in head and neck cancer. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.89.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
B cells can regulate immune responses by presenting antigen, producing antigen-specific antibodies and immunomodulatory cytokines. Their role in the anti-tumor immune response is poorly understood. However, in many cancers including head and neck squamous cell carcinoma (HNSCC), intratumoral B cells correlate with better survival. HNSCC has two distinct etiologies (HPV−) and (HPV+) where patients who are HPV+ have increased B cell infiltration and respond better to therapy. We hypothesized that (1) intratumoral B cell phenotype is different between HPV+ and HPV− HNSCC (2) location within the tumor microenvironment (TME) is distinct and (3) antibodies produced by intratumoral B cell in HPV+ HNSCC are specific for viral antigens.
Using single-cell RNA sequencing and spectral flow cytometry, we observed that B cell signatures in HPV− HNSCC patients were predominantly memory B cells and plasma cells, while the signatures in HPV+ HNSCC were naïve and germinal center (GC) B cells. Further, we quantified B cells in tertiary lymphoid structures (TLS) using multispectral immunofluorescence, and the presence of GC-rich TLS were increased in HPV+ patients. In fact, GC-rich TLS within the tumor of HPV+ patients correlated with increased overall survival. Overall, high enrichment for GC B cells were positively associated with longer progression-free survival. Antibodies produced by intratumoral B cells from HPV+ patients were positive for HPV viral antigens. Ultimately, characterization of B cell phenotype and function in HNSCC is important for devising new therapeutic options for cancer patients. Specifically, therapeutics to enhance B cell responses in the TME should be prioritized as a compliment to T-cell mediated therapies.
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Affiliation(s)
- Ayana T Ruffin
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Anthony R Cillo
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Tracey Tabib
- 2Department of Medicine, University of Pittsburgh School of Medicine
| | - Angen Liu
- 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sayali Onkar
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Sheryl Kunning
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Caleb Lampfield
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Irina Abecassis
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Zengbiao Qi
- 2Department of Medicine, University of Pittsburgh School of Medicine
| | - Ryan Soose
- 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Umamaheswar Duvvuri
- 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Seungwon Kim
- 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Robert Lafyatis
- 2Department of Medicine, University of Pittsburgh School of Medicine
| | - Robert L Ferris
- 3Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dario Vignali
- 1Department of Immunology, University of Pittsburgh School of Medicine
| | - Tullia C Bruno
- 1Department of Immunology, University of Pittsburgh School of Medicine
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11
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Thaler E, Schwab R, Maurer J, Soose R, Larsen C, Stevens S, Stevens D, Boon M, Huntley C, Doghramji K, Waters T, Kominsky A, Steffen A, Kezirian E, Hofauer B, Sommer U, Withrow K, Strohl K, Heiser C. Results of the ADHERE upper airway stimulation registry and predictors of therapy efficacy. Laryngoscope 2019; 130:1333-1338. [PMID: 31520484 PMCID: PMC7217178 DOI: 10.1002/lary.28286] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/15/2019] [Accepted: 08/19/2019] [Indexed: 01/20/2023]
Abstract
Objective/Hypothesis The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patients receiving UAS for treatment of OSA. Study Design Cohort Study. Methods Demographic and sleep study data collection occurred at baseline, implantation visit, post‐titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post hoc univariate and multivariate analysis was used to identify predictors of therapy response, defined as ≥50% decrease in Apnea‐Hypopnea Index (AHI) and AHI ≤20 at the 12‐month visit. Results The registry has enrolled 1,017 patients from October 2016 through February 2019. Thus far, 640 patients have completed their 6‐month follow‐up and 382 have completed the 12‐month follow‐up. After 12 months, median AHI was reduced from 32.8 (interquartile range [IQR], 23.6–45.0) to 9.5 (IQR, 4.0–18.5); mean, 35.8 ± 15.4 to 14.2 ± 15.0, P < .0001. Epworth Sleepiness Scale was similarly improved from 11.0 (IQR, 7–16) to 7.0 (IQR, 4–11); mean, 11.4 ± 5.6 to 7.2 ± 4.8, P < .0001. Therapy usage was 5.6 ± 2.1 hours per night after 12 months. In a multivariate model, only female sex and lower baseline body mass index remained as significant predictors of therapy response. Conclusions Across a multi‐institutional study, UAS therapy continues to show significant improvement in subjective and objective OSA outcomes. This analysis shows that the therapy effect is durable and adherence is high. Level of Evidence 2 Laryngoscope, 130:1333–1338, 2020
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Affiliation(s)
- Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard Schwab
- Penn Sleep Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joachim Maurer
- Sleep Disorders Center, University Hospital Mannheim, Mannheim, Germany
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher Larsen
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Suzanne Stevens
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Damien Stevens
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Karl Doghramji
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Tina Waters
- Cleveland Clinic Health System, Cleveland Clinic, Cleveland, Ohio
| | - Alan Kominsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Eric Kezirian
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Benedikt Hofauer
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Sommer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Kirk Withrow
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Kingman Strohl
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Clemens Heiser
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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12
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Strohl K, Schell A, Heiser C, Waters T, Steffen A, Maurer J, Strollo PJ, Soose R, Doghramji K, Schwab R, Withrow K. 0555 Absence Of Upper Airway Stimulation Surgical Learning Curve Effect On AHI And ESS Outcomes - Results From The Adhere Registry. Sleep 2019. [DOI: 10.1093/sleep/zsz067.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Amy Schell
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Armin Steffen
- Universitätsklinikum Schleswig-Holstein, Lubeck, Germany
| | | | | | - Ryan Soose
- University of Pittsburgh, Pittsburgh, PA, USA
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13
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Mesley MS, Edelman K, Sharpless J, Borrasso A, Billigen JB, Puffer R, Williams D, Benso S, Puccio AM, Schneider W, Soose R, Beers S, Kontos A, Collins M, Okonkwo DO. Impact of Multi-Disciplinary Care and Clinical Coach Coordinators on Participant Satisfaction and Retention in TBI Clinical Trials: A TEAM-TBI Study. Mil Med 2019; 184:155-159. [PMID: 30901471 DOI: 10.1093/milmed/usy386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Targeted Evaluation Action and Monitoring of Traumatic Brain Injury (TEAM-TBI) is a monitored, multiple interventional research identifying clinical profiles and assigns individualized, evidence-based treatment program. The objective of the current study was to assess overall participant satisfaction of the multi-disciplinary care team and approach. METHODS Between 2014 and 2017, 90 participants completed the 4-day TEAM-TBI clinical intake evaluation resulting in individualized treatment recommendations followed by a six-month intervention phase follow-up. Inclusion criteria were: age 18-60, history of chronic TBI (>6 months post-injury) with refractory clinical sequelae at screening (Post-Concussion Symptom Scale [PCSS] score >30). RESULTS A total of 85/90 (94%) participants completed the survey at baseline focusing on intake evaluation and approach; 90% of eligible participants also completed the follow-up time-point. Hundred percent of participants had a mean score of >4 across all questions at the initial time point." CONCLUSIONS The multi-disciplinary care approach and individualized treatment plans of the TEAM-TBI study yielded high participant retention and satisfaction scores. The Clinical Coach component of the trial was one of the highest rated aspects of the program and was associated with participant motivation and high retention rates.
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Affiliation(s)
- Matthew S Mesley
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Kathryn Edelman
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Jane Sharpless
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Allison Borrasso
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Julia B Billigen
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Ross Puffer
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Dana Williams
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Steven Benso
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Ava M Puccio
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Walt Schneider
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Ryan Soose
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Sue Beers
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Anthony Kontos
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - Michael Collins
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
| | - David O Okonkwo
- University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA
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14
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Heiser C, Steffen A, Boon M, Hofauer B, Doghramji K, Maurer JT, Sommer JU, Soose R, Strollo PJ, Schwab R, Thaler E, Withrow K, Kominsky A, Larsen C, Kezirian EJ, Hsia J, Chia S, Harwick J, Strohl K, Mehra R. Post-approval upper airway stimulation predictors of treatment effectiveness in the ADHERE registry. Eur Respir J 2019; 53:13993003.01405-2018. [PMID: 30487205 PMCID: PMC6319796 DOI: 10.1183/13993003.01405-2018] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023]
Abstract
Upper airway stimulation (UAS) has been shown to reduce severity of obstructive sleep apnoea. The aim of this study was to identify predictors of UAS therapy response in an international multicentre registry.Patients who underwent UAS implantation in the United States and Germany were enrolled in an observational registry. Data collected included patient characteristics, apnoea/hypopnoea index (AHI), Epworth sleepiness scale (ESS), objective adherence, adverse events and patient satisfaction measures. Post hoc univariate and multiple logistic regression were performed to evaluate factors associated with treatment success.Between October 2016 and January 2018, 508 participants were enrolled from 14 centres. Median AHI was reduced from 34 to 7 events·h-1, median ESS reduced from 12 to 7 from baseline to final visit at 12-month post-implant. In post hoc analyses, for each 1-year increase in age, there was a 4% increase in odds of treatment success. For each 1-unit increase in body mass index (BMI), there was 9% reduced odds of treatment success. In the multivariable model, age persisted in serving as statistically significant predictor of treatment success.In a large multicentre international registry, UAS is an effective treatment option with high patient satisfaction and low adverse events. Increasing age and reduced BMI are predictors of treatment response.
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Affiliation(s)
- Clemens Heiser
- Dept of Otorhinolaryngology, Head and Neck Surgery, Munich Technical University, Munich, Germany
| | - Armin Steffen
- Dept of Otorhinolaryngology, University of Lubeck, Lubeck, Germany
| | - Maurits Boon
- Dept of Otorhinolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Benedikt Hofauer
- Dept of Otorhinolaryngology, Head and Neck Surgery, Munich Technical University, Munich, Germany
| | - Karl Doghramji
- Dept of Otorhinolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joachim T Maurer
- Dept of Otorhinolaryngology, Head and Neck Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany
| | - J Ulrich Sommer
- Dept of Otorhinolaryngology, Head and Neck Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany
| | - Ryan Soose
- Dept of Otorhinolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Strollo
- Dept of Otorhinolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard Schwab
- Dept of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Thaler
- Dept of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kirk Withrow
- Dept of Otorhinolaryngology, University of Alabama, Birmingham, AL, USA
| | - Alan Kominsky
- Dept of Otorhinolaryngology, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Larsen
- Dept of Otorhinolaryngology - Head and Neck Surgery, Kansas University Medical Center, Kansas City, KS, USA
| | - Eric J Kezirian
- Dept of Otorhinolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hsia
- Dept of Otorhinolaryngology - Head and Neck Surgery, University of Minnesota Fairview Hospital, Minneapolis, MN, USA
| | - Stanley Chia
- Dept of Otorhinolaryngology, MedStar Washington Hospital Center, Washington, DC, USA
| | - John Harwick
- Dept of Otorhinolaryngology - Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Kingman Strohl
- Dept of Pulmonary and Critical Care Medicine and Sleep Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Reena Mehra
- Dept of Otorhinolaryngology, Cleveland Clinic, Cleveland, OH, USA
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15
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Parikh V, Thaler E, Kato M, Gillespie MB, Nguyen S, Withrow K, Calhoun D, Soose R, Stevens D, Stevens S, Larsen C, Reddy M, Lakkireddy D. Early feasibility of hypoglossal nerve upper airway stimulator in patients with cardiac implantable electronic devices and continuous positive airway pressure-intolerant severe obstructive sleep apnea. Heart Rhythm 2018; 15:1165-1170. [DOI: 10.1016/j.hrthm.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 11/24/2022]
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16
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Schell A, Baniak L, Hall D, Soose R, Strollo P. 0473 The Relationship Between Frailty and Sleep-Disordered Breathing in an Otolaryngology-Based Sleep Population. Sleep 2018. [DOI: 10.1093/sleep/zsy061.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Schell
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - L Baniak
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - D Hall
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - R Soose
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - P Strollo
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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17
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Strollo PJ, Withrow K, Schell A, Soose R, Mehra R, Schwab R, Strohl K, Doghramji K. 0536 Response to Upper Airway Stimulation in Older Adults with Moderate to Severe Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - K Withrow
- University of Alabama, Birmingham, AL
| | - A Schell
- University of Pittsburgh, Pittsburgh, PA
| | - R Soose
- University of Pittsburgh, Pittsburgh, PA
| | - R Mehra
- Cleveland Clinic, Cleveland, OH
| | - R Schwab
- University of Pennsylvania, Philadelphia, PA
| | - K Strohl
- Case Western Reserve, Cleveland, OH
| | - K Doghramji
- Thomas Jefferson University, Philadelphia, PA
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18
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Boon M, Huntley C, Steffen A, Maurer JT, Sommer JU, Schwab R, Thaler E, Soose R, Chou C, Strollo P, Kezirian EJ, Chia S, Withrow K, Weidenbecher M, Strohl K, Doghramji K, Hofauer B, Heiser C. Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry. Otolaryngol Head Neck Surg 2018; 159:379-385. [DOI: 10.1177/0194599818764896] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients’ symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.
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Affiliation(s)
- Maurits Boon
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin Huntley
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | - Richard Schwab
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Courtney Chou
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Eric J. Kezirian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Stanley Chia
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | | | - Karl Doghramji
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Luyster F, Strollo P, Soose R, Strohl K. Upper airway stimulation effectively treats REM obstructive sleep apnea. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Diercks GR, Wentland C, Keamy D, Kinane TB, Skotko B, de Guzman V, Grealish E, Dobrowski J, Soose R, Hartnick CJ. Hypoglossal Nerve Stimulation in Adolescents With Down Syndrome and Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2017; 144:37-42. [PMID: 29098288 DOI: 10.1001/jamaoto.2017.1871] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Obstructive sleep apnea (OSA) affects up to 60% of children with Down syndrome (DS) and may persist in half of patients after adenotonsillectomy. Children with DS who have persistent OSA often do not tolerate treatment with positive pressure airway support devices or tracheotomy for their residual moderate to severe OSA. The hypoglossal nerve stimulator is an implantable device that delivers an electrical impulse to anterior branches of the hypoglossal nerve in response to respiratory variation, resulting in tongue base protrusion that alleviates upper airway obstruction in adults. Objective To determine whether hypoglossal nerve stimulation is safe and effective in children with DS. Design, Setting, and Participants Case series of the first 6 adolescents with DS to undergo hypoglossal nerve stimulator implantation. Participants were 6 children and adolescents (12-18 years) with DS and severe OSA (apnea hypopnea index [AHI] > 10 events/h) despite prior adenotonsillectomy. Intervention Inspire hypoglossal nerve stimulator placement. Main Outcomes and Measures Patients were monitored for adverse events. Adherence to therapy was measured by hours of use recorded by the device. Efficacy was evaluated by comparing AHI and OSA-18, a validated quality-of-life instrument, scores at baseline and follow-up. Results In 6 patients (4 male, 2 female; aged 12-18 years), hypoglossal nerve stimulator therapy was well tolerated (mean use, 5.6-10.0 h/night) and effective, resulting in significant improvement in OSA. At 6- to 12-month follow-up, patients demonstrated a 56% to 85% reduction in AHI, with an overall AHI of less than 5 events/h in 4 children and less than 10 events/h in 2 children. Children also demonstrated a clinically significant improvement (mean [SD] overall change score, 1.5 [0.6]; range, 0.9-2.3) on the OSA-18, a validated quality-of-life instrument. Conclusions and Relevance Hypoglossal nerve stimulation was well tolerated and effective in the study population, representing a potential therapeutic option for patients with DS and refractory OSA after adenotonsillectomy who are unable to tolerate positive pressure airway devices. Trial Registration clinicaltrials.gov Identifier: NCT2344108.
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Affiliation(s)
- Gillian R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
| | - Carissa Wentland
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio.,Rainbow Babies and Children's Hospital, Case Western University, Cleveland, Ohio
| | - Donald Keamy
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Pediatric Sleep Associates, Massachusetts General Hospital for Children, Boston
| | - Thomas Bernard Kinane
- Pediatric Sleep Associates, Massachusetts General Hospital for Children, Boston.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian Skotko
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston
| | - Vanessa de Guzman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Ellen Grealish
- Pediatric Sleep Associates, Massachusetts General Hospital for Children, Boston
| | - John Dobrowski
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
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21
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Huntley C, Kaffenberger T, Doghramji K, Soose R, Boon M. Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: An Evaluation and Comparison of Outcomes at Two Academic Centers. J Clin Sleep Med 2017; 13:1075-1079. [PMID: 28728614 DOI: 10.5664/jcsm.6726] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/14/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES Data from patients at Thomas Jefferson University Hospital (TJUH) and University of Pittsburgh Medical Center (UPMC) undergoing upper airway stimulation (UAS) were analyzed. We hypothesize that treatment with UAS will improve both subjective and objective outcome measures and results will be reproducible between institutions. METHODS We reviewed patients undergoing UAS between May 2014 and August 2016. We recorded demographic data, Epworth Sleepiness Scale (ESS), and preoperative and postoperative polysomnographic information. We compared outcome data between institutions and subsequently combined the cohorts and compared baseline to posttreatment results. RESULTS The TJUH cohort consisted of 30 males and 18 females with a mean age of 60.88 years and body mass index of 29.29. The mean preoperative apnea-hypopnea index (AHI), O2 nadir, and ESS were 35.88, 80.96, and 11.09, respectively. The mean postoperative AHI, O2 nadir, and ESS were 6.34, 88.04, and 5.77, respectively. The UPMC cohort consisted of 30 males and 19 females with a mean age of 62.84 years and body mass index of 27.74. The mean preoperative AHI, O2 nadir, and ESS were 35.29, 79.58, and 10.94, respectively. The mean postoperative AHI, O2 nadir, and ESS were 6.28, 84.35, and 6.60, respectively. We found no difference in patients reaching a postoperative AHI less than 15, 10, and 5 when comparing the cohorts. After combining cohorts, we found a significant improvement in postoperative AHI, O2 nadir, and ESS compared to preoperative values. CONCLUSIONS UAS appears to provide a viable alternative to continuous positive airway pressure, producing improvement in both polysomnographic and quality-of-life measures. Results are reproducible at high-volume centers.
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Affiliation(s)
- Colin Huntley
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Karl Doghramji
- Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Soose
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maurits Boon
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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22
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Strollo PJ, Soose R, Badr M, Strohl KP. 0563 UPPER AIRWAY STIMULATION FOR OBSTRUCTIVE SLEEP APNEA: OBJECTIVE AND PATIENT REPORTED OUTCOMES AFTER FIVE YEARS OF FOLLOW-UP. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Green KK, Kent D, D’Agostino M, Hoff P, Soose R, Yaremchuk K, Lin H, Gillespie MB, Liu S, Capasso R, Carrasco M, Woodson BT, Thaler E, Barrera J, Kezirian EJ. 0566 DRUG-INDUCED SLEEP ENDOSCOPY AND SURGICAL OUTCOMES: AN INTERNATIONAL, MULTICENTER COHORT STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Luyster FS, Strollo PJ, Soose R, Strohl KP. 0565 THE IMPACT OF UPPER AIRWAY STIMULATION ON THE REM AHI. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Diercks GR, Keamy D, Kinane TB, Skotko B, Schwartz A, Grealish E, Dobrowski J, Soose R, Hartnick CJ. Hypoglossal Nerve Stimulator Implantation in an Adolescent With Down Syndrome and Sleep Apnea. Pediatrics 2016; 137:peds.2015-3663. [PMID: 27244805 DOI: 10.1542/peds.2015-3663] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is more common in children with Down syndrome, affecting up to 60% of patients, and may persist in up to 50% of patients after adenotonsillectomy. These children with persistent moderate to severe OSA require continuous positive airway pressure, which is often poorly tolerated, or even tracheotomy for severe cases. The hypoglossal nerve stimulator is an implantable device that produces an electrical impulse to the anterior branches of the hypoglossal nerve, resulting in tongue protrusion in response to respiratory variation. It is an effective treatment of sleep apnea in select adult patients because it allows for alleviation of tongue base collapse, improving airway obstruction. Herein we describe the first pediatric hypoglossal nerve stimulator implantation, which was performed in an adolescent with Down syndrome and refractory severe OSA (apnea hypopnea index [AHI]: 48.5 events/hour). The patient would not tolerate continuous positive airway pressure and required a long-standing tracheotomy. Hypoglossal nerve stimulator therapy was well tolerated and effective, resulting in significant improvement in the patient's OSA (overall AHI: 3.4 events/hour; AHI: 2.5-9.7 events/hour at optimal voltage settings depending on sleep stage and body position). Five months after implantation, the patient's tracheotomy was successfully removed and he continues to do well with nightly therapy.
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Affiliation(s)
- Gillian R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Departments of Otology and Laryngology and
| | - Donald Keamy
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Departments of Otology and Laryngology and Pediatric Sleep Associates and
| | - Thomas Bernard Kinane
- Pediatric Sleep Associates and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian Skotko
- Pediatrics, Harvard Medical School, Boston, Massachusetts; Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Allison Schwartz
- Pediatrics, Harvard Medical School, Boston, Massachusetts; Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; and
| | | | - John Dobrowski
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Departments of Otology and Laryngology and
| | - Ryan Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Departments of Otology and Laryngology and
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26
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Strollo P, Soose R, Strohl K. Safety and efficacy of upper airway stimulation in treatment of obstructive sleep apnea. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Fernando HC, Sasatomi E, Christie NA, Buenaventura PO, Finkelstein SD, Yousem SA, Soose R, Close JM, Luketich JD. Comparison of mutational changes in involved N1 lymph nodes with those in primary tumors in stage II non–small cell lung cancer: a pilot study. J Thorac Cardiovasc Surg 2004; 127:87-91. [PMID: 14752417 DOI: 10.1016/j.jtcvs.2003.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Surgical resection is the standard treatment for stage II non-small cell lung cancer, but recurrence rates approach 60%. This study compared mutational changes in involved lymph nodes and primary tumors from patients with stage II non-small cell lung cancer to determine whether risk factors for recurrence could be identified. METHODS Forty patients with resected stage II non-small cell lung cancer (excluding T3 N0 disease) were studied. Microdissection was performed on primary tumors and lymph nodes. Analysis was performed across 9 genomic loci by using polymerase chain reaction amplification. The ratio of fractional allelic loss between involved lymph nodes and primary tumors was used to stratify patients into high-risk (fractional allelic loss ratio of >or=1) and low-risk (fractional allelic loss ratio of <1) groups. RESULTS The median age of the patients was 68 years (range, 42-85 years). Median follow-up was 30 months. Fractional allelic loss was greater in patients with squamous carcinomas compared with that in adenocarcinomas, but survival was similar (35 vs 39 months). The median survival was 35 months in high-risk patients and was not reached in low-risk patients (P =.3). Disease-free survival was 24 months in high-risk patients and was not reached in low-risk patients (P =.35). In the subset with adenocarcinoma (n = 18), median survival was 24 months in the high-risk group; no deaths occurred in low-risk patients (P =.01). Also, disease-free survival was 14 months in high-risk patients and was not reached in the low-risk patients (P =.05). CONCLUSIONS Squamous cancers demonstrate greater mutational changes than adenocarcinomas; this does not affect outcome. The patients with low-risk adenocarcinomas demonstrated superior outcomes compared with those of other patients. These results should be confirmed in larger studies.
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Affiliation(s)
- Hiran C Fernando
- Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center Health System, UPMC Presbyterian, PA 15213, USA.
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