Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center

2021 ◽  
Author(s):  
Peter Michael Baptista ◽  
Carlos Prieto-Matos ◽  
Manuel Alegre-Esteban ◽  
Elena Urrestarazu-Bolumburu ◽  
Juan Alcade Navarrete
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nerve Stimulation ◽  
Implementation Strategy ◽  
Hypoglossal Nerve ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Early Results ◽  
Obstructive Sleep

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

2020 ◽  
Vol 162 (3) ◽  
pp. 400-407 ◽  
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.

scholarly journals Prevalence of Atrial Fibrillation in Obstructive Sleep Apnea Patients in a Tertiary Care Center

2020 ◽  
Vol 58 (222) ◽  
Author(s):  
Subodh Sagar Dhakal ◽  
Asmita Neupane ◽  
Mahesh Bhattarai ◽  
Dambar Bahadur Karki
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Care Center ◽  
Tertiary Care ◽  
Research Centre ◽  
Tertiary Care Center ◽  
Obstructive Sleep ◽  
Male Patients

Introduction: Atrial fibrillation is the most common sustained arrhythmias.Recently there has been evidence of higher prevalence of atrial fibrillation in obstructive sleep apnea patients compared to the general population. The aim of this study was to find the prevalence of atrial fibrillation in patients of obstructive sleep apnea in a tertiary care center. Methods: This descriptive cross-sectional study was done in Om Hospital and Research Centre from January 2016 to 2018 March after ethical clearance. Convenience sampling was done. Data was collected and entry was done in microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of atrial fibrillation in patients with obstructive sleep apnea is 7 (10.44%) at 95% Confidence Interval (6.70-14.17%). Apnoea–Hypopnoea Index of more than 30was present in 3 (42.8%) patients of atrial fibrillation. Atrial fibrillation was seen highest, 3 (42.8%) in patients with BMI more than 30 and lowest, 1 (14.28%) patients with BMI less than 23.5. Prevalence of atrial fibrillation was seen 5 (71.4%) in male patients and 2 (28.57%) in female patients. Sixty seven (75.28%) patients had obstructive sleep apnea in which male patients was predominant 48 (71.64%). Conclusions: Prevalence ofatrial fibrillation in patients of obstructive sleep apnea was found to higher than the similar studies done. It is important to obtain detail cardiac history in any patients with obstructive sleep apnea and look for arrhythmias speciallyatrial fibrillation.

scholarly journals Screening for obstructive sleep apnea in a diabetic retinopathy clinic in a tertiary care center

2021 ◽  
Vol 69 (11) ◽  
pp. 3349
Author(s):  
Sandeep Bansal ◽  
Rakesh Kaswan ◽  
Reema Bansal ◽  
Deeksha Katoch ◽  
Mohit Dogra ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Diabetic Retinopathy ◽  
Sleep Apnea ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Obstructive Sleep

Prediction of obstructive sleep apnea in patients presenting to a tertiary care center

2006 ◽  
Vol 10 (3) ◽  
pp. 147-154 ◽  
Author(s):  
S.K. Sharma ◽  
V. Malik ◽  
C. Vasudev ◽  
Amit Banga ◽  
Alladi Mohan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Obstructive Sleep

Tongue-Based Procedures in Treating Refractory Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-Analysis

FACE ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 65-70
Author(s):  
Paul B. Lee ◽  
Michael T. Chung ◽  
Jared Johnson ◽  
Jordyn Lucas ◽  
Caitlin R. Priest ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Nerve Stimulation ◽  
Hypoglossal Nerve ◽  
Meta Analysis ◽  
Apnea Hypopnea Index ◽  
Hypoglossal Nerve Stimulation ◽  
Obstructive Sleep

Objective: There is a high prevalence of obstructive sleep apnea (OSA) in pediatric and adult Down Syndrome (DS) patients that is refractory to adenotonsillectomy and continuous positive airway pressure. Newer treatment modalities have emerged with improved outcomes. The objective is to provide an updated systematic review and meta-analysis to analyze the clinical outcomes of OSA in pediatric and adult DS patients with hypoglossal nerve stimulation using Inspire, midline posterior glossectomy plus lingual tonsillectomy (MPG + LT), and combined genioglossus advancement plus radiofrequency (GGS + RF). Methods: A comprehensive literature search of PubMed and Google Scholar was performed followed by a meta-analysis. Studies with preoperative and post-operative Apnea Hypopnea Index (AHI) values were included with patients serving as their own control. Results: Across 5 studies, 56 patients were analyzed. The mean reduction in AHI was statistically significant before vs. after procedure ( P < .001 for hypoglossal nerve stimulation using Inspire with a paired 2-tailed t-test and P = .031 for MPG + LT). Although individual patient AHI values were unavailable in the GGS + RF study, the standard difference in mean AHI was also significant for GGS + RF with P = .001. Device malfunction was the most common complication for Inspire while postoperative bleeding was observed for MPG + LT and nasopharyngeal obstruction and retropalatal collapse were observed for GGS + RF. Conclusion: This review reveals significant improvement in AHI with Inspire, MPG + LT, and GGS + RF for DS patients with refractory OSA. Further investigation is needed for comparison between these 3 therapies.

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