Success of Hypoglossal Nerve Stimulation Using Mandibular Advancement During Sleep Endoscopy

Overview

Journal Laryngoscope

Specialty Otorhinolaryngology

Date 2020 Feb 29

PMID 32108345

Citations 6

Authors

Graeme B Mulholland

Raj C Dedhia

Affiliations

Soon will be listed here.

Abstract

Objectives/hypothesis: Hypoglossal nerve stimulation (HGNS) effectively treats obstructive sleep apnea in select patients. Drug-induced sleep endoscopy (DISE) is required for HGNS candidacy. Data suggest that mandibular advancement (MA) devices and HGNS share similar target populations. We aimed to test the association between MA's effect on the velum and lateral walls during DISE in relation to the improvement in the apnea-hypopnea index (AHI) with HGNS.

Study Design: Prospective case series METHODS: All patients completed preoperative polysomnography or home sleep study, DISE with MA prior to HGNS implantation, and full-night efficacy sleep tests. Adult patients with body mass index (BMI) ≤ 35 and AHI ≥ 15 were included. Two independent reviewers scored DISE videos.

Results: Forty-six patients were included from October 2015 to January 2019. Mean BMI (standard deviation) was 28.5 (3.7) kg/m . Patients with a reduced airway response to MA had greater AHI improvement than patients with a robust response (21.7, 95% confidence interval [CI]: 14.4 to 29.0 vs. 4.9, 95% CI: -8.9 to 18.6; P = .03). Patients with complete baseline collapse at the velum and lateral walls (n = 11) had less response compared to those with partial collapse (n = 35) (AHI reduction of 4.4 [95% CI: -8.6 to 17.4] vs. 22.3 [95% CI: 15.1 to 29.6; P = .02]).

Conclusions: Patients having significant airway improvement in the upper pharynx with MA during DISE appear less likely to succeed with HGNS. This phenomenon might be secondary to the worsened baseline obstruction of the upper pharynx in such patients.

Level Of Evidence: 4 Laryngoscope, 2020.

Citing Articles

Baseline Characteristics Associated with Hypoglossal Nerve Stimulation Treatment Outcomes in Patients with Obstructive Sleep Apnea: A Systematic Review.

Tukanov E, Van Loo D, Dieltjens M, Verbraecken J, Vanderveken O, Op de Beeck S Life (Basel). 2024; 14(9).

PMID: 39337912 PMC: 11433192. DOI: 10.3390/life14091129.

The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea.

Viana A, Estevao D, Zhao C Ann Med. 2022; 54(1):2909-2920.

PMID: 36269026 PMC: 9590429. DOI: 10.1080/07853890.2022.2134586.

Obstruction level associated with outcome in hypoglossal nerve stimulation.

Wirth M, Bautz M, von Meyer F, Hofauer B, Strassen U, Heiser C Sleep Breath. 2021; 26(1):419-427.

PMID: 34091793 PMC: 8857010. DOI: 10.1007/s11325-021-02396-y.

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

Huyett P, Kent D, DAgostino M, Green K, Soose R, Kaffenberger T Laryngoscope. 2021; 131(7):1676-1682.

PMID: 33443811 PMC: 8362605. DOI: 10.1002/lary.29396.

A prognostic star was born: drug-induced sleep endoscopy for hypoglossal nerve stimulation.

Dedhia R, Huyett P J Clin Sleep Med. 2020; 16(S1):15-16.

PMID: 33054960 PMC: 7792890. DOI: 10.5664/jcsm.8882.

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