Comparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty: A Single University Experience

Introduction: Expansion sphincter pharyngoplasty (ESP) is a surgical option for patients with obstructive sleep apnea (OSA). Upper airway stimulation (UAS) is an alternative that has shown success in initial outcomes studies. We compare outcomes of a cohort of patients undergoing UAS to ESP. Methods: We compared demographic and polysomnographic data of the UAS to ESP cohorts. We also calculated the proportion of patients achieving surgical success. Results: The ESP cohort consisted of 33 patients. The mean preoperative Apnea-Hypopnea Index (AHI), O2 nadir, Epworth Sleepiness Scale (ESS), and BMI were 36.47 ± 20.01, 82.63 ± 5.37, 10.69 ± 4.42, and 29.6 ± 4.49, which improved to 13.47 ± 18.74, 84.84 ± 5.48, 7.00 ± 5.81, and 29.92 ± 4.59 postoperatively. There was a 63.64% success rate. The UAS cohort consisted of 75 patients. The mean preoperative AHI, O2 nadir, ESS, and BMI were 36.76 ± 20.72, 80.24 ± 8.43, 11.18 ± 4.16, and 29.50 ± 3.96, which improved to 7.25 ± 11.19, 88.71 ± 3.25, 5.36 ± 3.35, and 29.36 ± 3.68 postoperatively. The success rate was 86.67%. We found a significant difference in gender, age, preoperative AHI, postoperative AHI, postoperative O2 nadir, surgical success, and patients reaching an AHI less than 10 and 5. Conclusion: Upper airway stimulation is a new surgical option for select patients with OSA showing comparable or improved outcomes to a cohort of patients undergoing ESP.

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Short-term results of upper airway stimulation in obstructive sleep apnoea patients: the Amsterdam experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000961 ◽

2020 ◽

Vol 134 (5) ◽

pp. 447-452

Author(s):

P E Vonk ◽

M J L Ravesloot ◽

J P van Maanen ◽

N de Vries

Keyword(s):

Obstructive Sleep Apnoea ◽

Upper Airway ◽

Sleep Apnoea ◽

Consecutive Series ◽

Short Term ◽

Drug Induced ◽

Upper Airway Stimulation ◽

Surgical Success ◽

Obstructive Sleep ◽

Significant Difference

AbstractObjectivesThis paper aimed to: retrospectively analyse single-centre results in terms of surgical success, respiratory outcomes and adverse events after short-term follow up in obstructive sleep apnoea patients treated with upper airway stimulation; and evaluate the correlation between pre-operative drug-induced sleep endoscopy findings and surgical success.MethodsA retrospective descriptive cohort study was conducted, including a consecutive series of obstructive sleep apnoea patients undergoing implantation of an upper airway stimulation system.ResultsForty-four patients were included. The total median Apnoea–Hypopnea Index and oxygen desaturation index significantly decreased from 37.6 to 8.3 events per hour (p < 0.001) and from 37.1 to 15.9 events per hour (p < 0.001), respectively. The surgical success rate was 88.6 per cent, and did not significantly differ between patients with or without complete collapse at the retropalatal level (p = 0.784). The most common therapy-related adverse event reported was (temporary) stimulation-related discomfort.ConclusionUpper airway stimulation is an effective and safe treatment in obstructive sleep apnoea patients with continuous positive airway pressure intolerance or failure. There was no significant difference in surgical outcome between patients with tongue base collapse with or without complete anteroposterior collapse at the level of the palate.

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The Impact of Upper Airway Stimulation on Swallowing Function

Ear Nose & Throat Journal ◽

10.1177/0145561319853519 ◽

2019 ◽

Vol 98 (8) ◽

pp. 496-499 ◽

Cited By ~ 1

Author(s):

Colin Huntley ◽

Adam Vasconcellos ◽

Michael Mullen ◽

David W. Chou ◽

Haley Geosits ◽

...

Keyword(s):

Assessment Tool ◽

Medical Center ◽

Academic Medical Center ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Swallowing Function ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

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The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

International Archives of Otorhinolaryngology ◽

10.1055/s-0038-1648248 ◽

2018 ◽

Vol 22 (04) ◽

pp. 432-436 ◽

Cited By ~ 1

Author(s):

Francesco Lorusso ◽

Francesco Dispenza ◽

Domenico Modica ◽

Salvatore Gallina

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Obstructive Sleep ◽

Müller Maneuver ◽

Expansion Sphincter Pharyngoplasty ◽

Sphincter Pharyngoplasty ◽

Apnea Syndrome

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

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Surgical Outcomes of Trabeculectomy in Uveitic Glaucoma: A Long-Term, Single-Center, Retrospective Case-Control Study

Journal of Ophthalmology ◽

10.1155/2021/5550776 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Rina Kanaya ◽

Riki Kijima ◽

Yasuhiro Shinmei ◽

Akihiro Shinkai ◽

Takeshi Ohguchi ◽

...

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Success Rates ◽

Uveitic Glaucoma ◽

Surgical Success ◽

Case Series Study ◽

Significant Difference ◽

The Mean ◽

Age And Sex

Purpose. To evaluate the long-term outcomes of trabeculectomy with mitomycin C (MMC-TLE) in patients with uveitic glaucoma (UG). Patients and Methods. This was a retrospective, nonrandomized case series study. MMC-TLE was performed on 50 eyes with UG between February 2001 and January 2015 at Hokkaido University Hospital. Age- and sex-matched patients with primary open angle glaucoma (POAG) who underwent MMC-TLE were matched by age and sex and enrolled as controls. Surgical success was defined as an intraocular pressure (IOP) less than 18 or 15 mmHg. The Kaplan–Meier survival curves for surgical failure were analyzed. Results. The mean preoperative IOP in UG and POAG was 27.6 ± 10.6 and 18.0 ± 4.5 mmHg, respectively. After the surgery, the mean IOP in UG and POAG was reduced to 11.7 ± 4.2 and 12.2 ± 3.8 mmHg at 12 months, 11.9 ± 7.0 and 12.1 ± 3.1 mmHg at 36 months, and 13.0 ± 5.2 and 10.6 ± 1.2 mmHg at 120 months, respectively. The success rates (IOP <18 mmHg, IOP reduction >20%) in UG and POAG were 91.7% and 88.0% at 12 months, 82.2% and 75.6% at 36 months, and 66.5% and 61.8% at 120 months, respectively. The success rates (IOP <15 mmHg) in UG and POAG were 64.0% and 58.0% at 12 months, 55.1% and 45.5% at 36 months, and 47.9% and 37.8% at 120 months, respectively. There was no significant difference in the success rate between UG and POAG at 120 months after surgery by either definition of surgical success. Conclusions. MMC-TLE effectively reduced IOP in both UG and POAG. There was no significant difference in the success rate between UG and POAG. Following sufficient inflammation suppression, surgical outcomes of UG may be comparable with those of POAG.

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Effect of Upper Airway Stimulation in Patients with Obstructive Sleep Apnea (EFFECT): A Randomized Controlled Crossover Trial

Journal of Clinical Medicine ◽

10.3390/jcm10132880 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2880

Author(s):

Clemens Heiser ◽

Armin Steffen ◽

Benedikt Hofauer ◽

Reena Mehra ◽

Patrick J. Strollo ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Crossover Trial ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Upper Airway Stimulation ◽

Sham Stimulation ◽

Randomized Controlled ◽

Obstructive Sleep ◽

Significant Difference

Background: Several single-arm prospective studies have demonstrated the safety and effectiveness of upper airway stimulation (UAS) for obstructive sleep apnea. There is limited evidence from randomized, controlled trials of the therapy benefit in terms of OSA burden and its symptoms. Methods: We conducted a multicenter, double-blinded, randomized, sham-controlled, crossover trial to examine the effect of therapeutic stimulation (Stim) versus sham stimulation (Sham) on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS). We also examined the Functional Outcomes of Sleep Questionnaire (FOSQ) on sleep architecture. We analyzed crossover outcome measures after two weeks using repeated measures models controlling for treatment order. Results: The study randomized 89 participants 1:1 to Stim (45) versus Sham (44). After one week, the AHI response rate was 76.7% with Stim and 29.5% with Sham, a difference of 47.2% (95% CI: 24.4 to 64.9, p < 0.001) between the two groups. Similarly, ESS was 7.5 ± 4.9 with Stim and 12.0 ± 4.3 with Sham, with a significant difference of 4.6 (95% CI: 3.1 to 6.1) between the two groups. The crossover phase showed no carryover effect. Among 86 participants who completed both phases, the treatment difference between Stim vs. Sham for AHI was −15.5 (95% CI −18.3 to −12.8), for ESS it was −3.3 (95% CI −4.4 to −2.2), and for FOSQ it was 2.1 (95% CI 1.4 to 2.8). UAS effectively treated both REM and NREM sleep disordered breathing. Conclusions: In comparison with sham stimulation, therapeutic UAS reduced OSA severity, sleepiness symptoms, and improved quality of life among participants with moderate-to-severe OSA.

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459 The Effect of Upper Airway Stimulation Therapy on Blood Pressure

SLEEP ◽

10.1093/sleep/zsab072.458 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A181-A181

Author(s):

Alex McKinlay ◽

Nick Scalzitti ◽

Ben Walters

Keyword(s):

Blood Pressure ◽

Standard Error ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Upper Airway ◽

Mean Difference ◽

Upper Airway Stimulation ◽

Pressure Therapy ◽

Significant Difference ◽

The Mean

Abstract Introduction Upper airway stimulation (UAS) therapy is a novel technique in the treatment of Obstructive Sleep Apnea (OSA). UAS therapy is indicated for patients with moderate to severe OSA who fail therapy with Continuous Positive Airway Pressure (CPAP) and/or the use of a dental appliance. Although research suggests that CPAP can modestly improve patients’ Blood Pressure (BP), little is known about the effect of UAS on BP. Methods Via a retrospective cross-sectional cohort study, we identified all patients undergoing UAS surgery at Brook Army Medical Center from July 2015 through July 2020. We captured pre-operative and post-operative data from a structured electronic medical record review, including Polysomnographic data and BP measurements at designated time points. We measured UAS therapy compliance in hours of usage per week. Statistical analysis includes paired T-tests to determine whether changes in BP and AHI were significant when comparing preoperative and postoperative values. Results We report data for 12 patients treated with Upper Airway Stimulation therapy in our cohort. The mean pre-operative Systolic Blood Pressure (SBP) is 128.3±7 mmHg, the mean post-operative SBP is 122.8±10 mmHg with a mean difference of -5.4mmHg (standard error for difference 2.9mmHg). The mean pre-operative Diastolic Blood Pressure (DBP) is 80.0±6 mmHg, the mean post-op DBP is 76.4±8 mmHg, with a mean difference of -3.6mmHg (standard error for difference 1.9 mmHg). Neither of these are statistically significant, with P values of 0.09 and 0.08 respectively. The mean pre-operative Mean Arterial Pressure (MAP) is 96.1±6 mmHg, the mean post-op MAP is 91.9± 8 mmHg, with a mean difference of -4.2 mmHg (standard error for difference 1.7 mmHg). This represents a statistically significant difference with a P value of 0.03. Seven patients carried a pre-operative diagnosis of Hypertension whereas five did not. There is not a statistical difference in BP changes between these subgroups. Conclusion Upper Airway Stimulation surgery appears to decrease SBP, DBP, and MAP measurements with a similar magnitude as Positive Airway Pressure Therapy. In our cohort, only MAP changes appear to reach statistically significance. Further studies are warranted to elucidate the clinical significance of UAS on physiologic parameters such as blood pressure. Support (if any):

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Upper Airway Stimulation in Patients Who Have Undergone Unsuccessful Prior Palate Surgery: An Initial Evaluation

Otolaryngology ◽

10.1177/0194599818792191 ◽

2018 ◽

Vol 159 (5) ◽

pp. 938-940 ◽

Cited By ~ 7

Author(s):

Colin Huntley ◽

Adam Vasconcellos ◽

Karl Doghramji ◽

Benedikt Hofauer ◽

Clemens Heiser ◽

...

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Upper Airway ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

Prior Surgery ◽

The Mean

Upper airway stimulation therapy (UAS) is a new option for treatment of obstructive sleep apnea (OSA) in patients unable to tolerate continuous positive airway pressure (CPAP). We set out to evaluate the effectiveness of UAS in patients who have undergone prior palate surgery. We designed a retrospective review and evaluated patients undergoing UAS at 2 academic centers. We recorded demographic and pre- and postoperative polysomnogram (PSG) data. We compared the cohort of patients who had undergone prior palate surgery, “prior surgery,” to the cohort who had not, “no prior surgery.” A total of 164 patients were included in the study: 23 in the prior surgery and 141 in the no prior surgery groups. The mean age was significantly higher in the no prior surgery group ( P = .020). There were no other significant differences when comparing demographic, quality of life, or PSG variables between cohorts. UAS therapy is an option to treat OSA in patients having undergone unsuccessful prior palate surgery.

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Upper airway stimulation: Fewer complications, ED presentations, readmissions, and increased surgical success

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.103035 ◽

2021 ◽

Vol 42 (5) ◽

pp. 103035

Author(s):

Matthew Stewart ◽

Leonard Estephan ◽

Hamad Sagheer ◽

Joseph M. Curry ◽

Maurits Boon ◽

...

Keyword(s):

Upper Airway ◽

Upper Airway Stimulation ◽

Surgical Success

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Facial Profile Shape, Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients

The Angle Orthodontist ◽

10.2319/011509-26.1 ◽

2010 ◽

Vol 80 (1) ◽

pp. 37-42 ◽

Cited By ~ 11

Author(s):

S. M. Banabilh ◽

A. R. Samsudin ◽

A. H. Suzina ◽

Sidek Dinsuhaimi

Keyword(s):

Obstructive Sleep Apnea ◽

Null Hypothesis ◽

Control Group ◽

Class Ii Malocclusion ◽

Chi Square ◽

Facial Profile ◽

Obstructive Sleep ◽

Significant Difference ◽

Chi Square Test ◽

The Mean

Abstract Objective: To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA). Materials and Methods: Subjects were 120 adult Malays aged 18 to 65 years (mean ± standard deviation [SD], 33.2 ± 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test. Results: Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m2 ± 6.5) than for the control group (22.7 kg/m2 ± 3.5; P < .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm ± 6.02; 129.1 mm Hg ± 17.55) than for the control group (35.6 cm ± 3.52; 114.1 mm Hg ± 13.67; P < .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P < .05), but no significant difference in palatal shape was found. Conclusion: The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.

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