Drug‐Induced Sleep Endoscopy and Hypoglossal Nerve Stimulation Outcomes: A Multicenter Cohort Study

Abstract Introduction Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients. Methods Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings. Results Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE. Conclusion In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study. Support Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)

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Preoperative Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599820901499 ◽

2020 ◽

Vol 162 (3) ◽

pp. 400-407 ◽

Cited By ~ 3

Author(s):

Roy Xiao ◽

Douglas K. Trask ◽

Alan H. Kominsky

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Effective Treatment ◽

Nerve Stimulation ◽

Hypoglossal Nerve ◽

Tertiary Care ◽

Drug Induced ◽

Hypoglossal Nerve Stimulation ◽

Obstructive Sleep ◽

Tongue Position

Objective Hypoglossal nerve stimulation (HGNS) is an effective treatment for patients with obstructive sleep apnea (OSA) who fail continuous positive airway pressure (CPAP). We assessed the relationship between patient characteristics and response to HGNS. Study Design Retrospective cohort study. Setting Single tertiary care institution. Subjects and Methods This study included CPAP-intolerant patients with moderate to severe OSA after HGNS system implantation from November 2015 to December 2017. Patient measures, drug-induced sleep endoscopy (DISE) findings, and apnea-hypopnea indices (AHIs) were recorded. Results Forty-eight patients underwent implantation with the following median measures: age, 66 years; body mass index, 28.6; and neck circumference, 41.0 cm. Patients were classified by Friedman tongue position (II, 27%; III, 56%; IV, 17%) and Mallampati grade (I, 25%; II, 50%; III, 23%; IV, 2%). By DISE, 71% had anterior-posterior palatal collapse. Additionally, 38% had lateral oropharynx collapse; 50%, tongue base collapse; and 27%, epiglottis collapse. Following implantation, median AHI improved from 38.5 to 2.7 ( P < .001), and 92% of patients had no worse than mild OSA (8% moderate). Patients with Friedman tongue position grade II/III experienced greater change in AHI as compared with grade IV (94.2% vs 73.8%, P < .001). Patients with Mallampati score I/II experienced greater improvement versus score III/IV (94.7% vs 66.5%, P < .001). No DISE findings, including any obstruction or collapse, were associated with change in AHI. Conclusion This study further confirms HGNS as an effective treatment of CPAP-intolerant OSA. Office measures such as Friedman tongue position IV and Mallampati III/IV were associated with mildly decreased response. DISE findings were not associated with patient response.

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Evaluation of In-Office Volitional Snore as a Screening Tool for Candidacy for Hypoglossal Nerve Stimulation

Otolaryngology ◽

10.1177/01945998211023733 ◽

2021 ◽

pp. 019459982110237

Author(s):

Pratyusha Yalamanchi ◽

Nicole Mott ◽

Syed Ahmed Ali ◽

Nithin S. Peddireddy ◽

Kevin J. Kovatch ◽

...

Keyword(s):

Nerve Stimulation ◽

Screening Tool ◽

Hypoglossal Nerve ◽

Cost Effective ◽

Drug Induced ◽

Chi Square ◽

Hypoglossal Nerve Stimulation ◽

Obstructive Sleep ◽

Chi Square Test ◽

Pattern Sensitivity

Candidacy evaluation for hypoglossal nerve stimulation (HGNS) is resource intensive. This proof-of-concept study investigates use of in-office volitional snore during flexible laryngoscopy as an efficient, cost-effective screening tool for HGNS evaluation. Adults with moderate to severe obstructive sleep apnea that failed continuous positive airway pressure treatment (n = 41) underwent evaluation for HGNS from 2018 to 2019. Volitional snore and drug-induced sleep endoscopy (DISE) data were collected and scored by VOTE classification (velum/palate, oropharynx, tongue base, epiglottis). A chi-square test of independence was performed that demonstrated a significant relationship between volitional snore and DISE (χ2 = 4.39, P = .036) for velum collapse pattern. Sensitivity and specificity of volitional snore for detecting velum collapse pattern were 93.6% (95% CI, 75.6%-99.2%) and 40% (95% CI, 12.2%-73.8%), respectively, illustrating its utility in screening for HGNS. Patients who demonstrate anterior-posterior velum collapse on volitional snore may be excellent candidates for confirmatory DISE at the time of HGNS implantation.

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