Adherence of Upper Airway Stimulation in US and German Medical Centers: A Multicenter Meta-Analysis on Adhere Registry

2020 ◽  
Author(s):  
Jingxin Lei ◽  
Kent Lee
Keyword(s):  
Meta Analysis ◽  
Upper Airway ◽  
Study Cohort ◽  
Significant Heterogeneity ◽  
Upper Airway Stimulation ◽  
Medical Centers ◽  
Obstructive Sleep ◽  
High Adherence ◽  
International Multicenter ◽  
Multicenter Registry

Abstract Upper airway stimulation (UAS) is shown to be effective with high adherence for patients with moderate to severe obstructive sleep apnea. However, the consistency of adherence among medical sites remains to be verified. This study examines the adherence to UAS among medical sites in an international multicenter registry. A statistically significant adherence decrease between 6-month and 12-month visit was found in the study cohort as well as in most sites. No significant heterogeneity was found among sites with either all patients or only patients who had adherence at both visits recorded. In addition, there is no enough evidence that region and experience of sites influences the adherence. This study indicates that UAS therapy adherence is consistent among sites, regardless of region and experience of sites.

Comparison of Traditional Upper Airway Surgery and Upper Airway Stimulation for Obstructive Sleep Apnea

2020 ◽  
pp. 000348942095317
Author(s):  
Colin Huntley ◽  
Maurits Boon ◽  
Samuel Tschopp ◽  
Kurt Tschopp ◽  
Carolyn M Jenks ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Sleep Surgery ◽  
Medical Centers ◽  
Academic Medical ◽  
Obstructive Sleep ◽  
Quality Life

Objective: To compare patients with moderate-severe obstructive sleep apnea (OSA) undergoing traditional single and multilevel sleep surgery to those undergoing upper airway stimulation (UAS). Study Design: Case control study comparing retrospective cohort of patients undergoing traditional sleep surgery to patients undergoing UAS enrolled in the ADHERE registry. Setting: 8 multinational academic medical centers. Subjects and Methods: 233 patients undergoing prior single or multilevel traditional sleep surgery and meeting study inclusion criteria were compared to 465 patients from the ADHERE registry who underwent UAS. We compared preoperative and postoperative demographic, quality of life, and polysomnographic data. We also evaluated treatment response rates. Results: The pre and postoperative apnea hypopnea index (AHI) was 33.5 and 15 in the traditional sleep surgery group and 32 and 10 in the UAS group. The postoperative AHI in the UAS group was significantly lower. The pre and postoperative Epworth sleepiness scores (ESS) were 12 and 6 in both the traditional sleep surgery and UAS groups. Subgroup analysis evaluated those patients undergoing single level palate and multilevel palate and tongue base traditional sleep surgeries. The UAS group had a significantly lower postoperive AHI than both traditional sleep surgery subgroups. The UAS group had a higher percentage of patients reaching surgical success, defined as a postoperative AHI <20 with a 50% reduction from preoperative severity. Conclusion: UAS offers significantly better control of AHI severity than traditional sleep surgery. Quality life improvements were similar between groups.

scholarly journals 0637 Comparison of AHI and ESS Outcomes Between Patients with Obstructive Sleep Apnea Undergoing Sleep Surgery versus Upper Airway Stimulation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A243-A243
Author(s):  
C Huntley ◽  
K Doghramji ◽  
K Tschopp ◽  
S Tschopp ◽  
P B Jardin ◽  
...  
Keyword(s):  
Chart Review ◽  
Upper Airway ◽  
Therapy Response ◽  
Upper Airway Stimulation ◽  
Surgical Interventions ◽  
Sleep Surgery ◽  
Obstructive Sleep ◽  
Multi Level ◽  
International Multicenter

Abstract Introduction Single or multi-level soft tissue surgical interventions are common options for CPAP-intolerant patients with OSA. Upper Airway Stimulation (UAS) is an alternative option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS. Methods We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. For both groups, post-op AHI was collected, including full-night UAS efficacy studies. Data are presented as mean and standard deviation. Results The TSS group (n=284) and UAS group (n=541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p&lt;0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p=0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p=0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p&lt;0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p=0.01). Using the Sher response criteria of 50% AHI reduction and ≤ 20 events/hour, UAS had a 70% response rate vs 51% for TSS. Conclusion This study represents largest and first international, multicenter comparison of UAS to traditional surgical interventions for OSA, albeit with limitations of potential differential patient selection. While both TSS and UAS show similar improvement in symptoms, upper airway stimulation has a larger reduction of AHI with higher rates of therapy response than traditional sleep surgery Support ADHERE data assistance from Inspire Medical (Minneapolis, MN)

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea

2021 ◽  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Novel Therapy ◽  
Upper Airway Stimulation ◽  
Current State ◽  
Obstructive Sleep ◽  
Long Term Follow Up ◽  
Physician Extenders ◽  
Primary Care Practitioners

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea provides the current state of knowledge regarding this novel therapy. It reviews the pathophysiologic basis of sleep apnea and the specific mechanism by which upper airway stimulation provides airway support in this disorder. It also provides practical insights into this therapy related to patient selection, clinical outcomes, surgical technique, long-term follow-up, and adverse events and offers recommendations for those aspiring to develop an upper airway stimulation program. It provides an overview of unique populations and circumstances that may extend the utility of the procedure, and that may provide challenges in management, as well as thoughts on the future of this technology. This textbook is intended for all practitioners who have interest or care for sleep disordered breathing, including sleep medicine physicians, pulmonologists, otolaryngologists, primary care practitioners, as well as physician extenders.

433 Insomnia and Restless Legs Syndrome in Patients with Upper Airway Stimulation Therapy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A171-A172
Author(s):  
Mohammed Jomha ◽  
Shalini Manchanda ◽  
Stephanie Stahl ◽  
Noah Parker
Keyword(s):  
Restless Legs Syndrome ◽  
Statistical Significance ◽  
Upper Airway ◽  
Post Treatment ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Therapy Adherence ◽  
Restless Legs ◽  
Obstructive Sleep ◽  
Pre Treatment

Abstract Introduction Insomnia and restless legs syndrome (RLS) are common sleep disorders that may impact obstructive sleep apnea (OSA) treatment. To our knowledge, no studies have investigated whether these comorbidities affect upper airway stimulation (UAS) therapy adherence and outcomes. This study aims to explore possible effects of insomnia and RLS in patients using UAS therapy. Methods All patients who underwent UAS system implantation for treatment of OSA at our facility were retrospectively studied. Pre- and post-implant histories and data, including diagnostic sleep testing, otolaryngology evaluation, activation results, and treatment evaluation, were analyzed. Patients with no insomnia or RLS were compared to patients with insomnia, RLS, or both. Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and adherence were compared pre- and post-treatment for each group. Results Sixty-four patients who have undergone UAS implantation at our center have completed post-treatment in-lab titration and evaluation of their UAS system. Insomnia was present in 47%, RLS in 28%, and both insomnia and RLS in 14%. In all groups, the overall AHI during in-lab titration was &gt;50% lower than the pre-treatment AHI (16.1+/-14.3/h vs 32.5+/-13.1/h, p&lt;0.001). While the trend in AHI reductions suggested a lower AHI in those without insomnia or RLS, the reduction did not reach statistical significance (no insomnia or RLS 15.7+/-12.9/h, insomnia 16.9+/-16.7/h, RLS 19.0+/-15.5/h, both insomnia and RLS 23.4+/-18.4/h). UAS therapy usage was reduced in patients with RLS (3.9+/-2.6 h/night, p=0.029) and in patients with both insomnia and RLS (3.9+/-1.3 h/night, p=0.046) compared to patients with neither comorbidity (5.9+/-1.9 h/night). Mean reduction in ESS was similar across groups, averaging from 11+/-5 pre-treatment to 7+/-5 post-treatment (p&lt;0.001). Conclusion Insomnia and RLS are common in patients using UAS therapy for OSA. Pre- and post-treatment residual AHI and ESS significantly improved in all patient groups assessed. A decrease in UAS usage was present in patients with RLS and both RLS and insomnia. Our study suggests that identification and treatment of RLS and insomnia may play an important role for UAS therapy adherence and efficacy, thus, optimizing care. Support (if any):

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

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