1129 Central Sleep Apnea after Hypoglossal Nerve Stimulation

Elevated Central and Mixed Apnea Index after Upper Airway Stimulation

“…In addition, there is an overall reduced sensitivity of brain chemoreceptors to CO 2 due to long-term exposure to nocturnal hypercapnia with sleep apnea. 20,[28][29][30] After UAS device activation, the resolution of sleep-related obstruction and restoration of normal lower nocturnal values of PCO 2 , coupled with decreased receptor chemosensitivity, may result in a blunted inspiratory drive. These events may eventually disappear with continuous OSA treatment and progressive adaptation of chemoreceptors to the new levels of nocturnal PCO 2 .…”

“…To date, there is only 1 case of treatment-emergent CSA after UAS reported in the literature. Chan et al 20 found that after implantation, their patient had a significant number of central apneas (respiratory event index [REI] 45 events/h, 25 central apneas) during in-laboratory device titration; however, the central apneas resolved after the patient's device configuration was changed to (---) 0.6 to 1.6 V to optimize stimulation of the tongue base during awake endoscopy (AHI 2.08 events/h). In our cohort, we found an overall low prevalence of possible treatment-emergent CSA (3.3%, n = 5).…”

“…It can be hypothesized that, before surgery, patients present with a high critical pressure for upper airway closure and, consequently, have obstructive apneas due to increased upper airway collapsibility. In addition, there is an overall reduced sensitivity of brain chemoreceptors to CO 2 due to long‐term exposure to nocturnal hypercapnia with sleep apnea 20,28–30 . After UAS device activation, the resolution of sleep‐related obstruction and restoration of normal lower nocturnal values of PCO 2 , coupled with decreased receptor chemosensitivity, may result in a blunted inspiratory drive.…”

“…As UAS continues to grow as a treatment for OSA, its performance must be critically assessed. Recently, the emergence of central sleep apnea has been reported after treating sleep apnea with UAS 20 . This phenomenon is known to occur with existing sleep apnea therapies, including CPAP, mandibular advanced devices (MADs), and upper airway surgery 21–23 .…”

“…Recently, the emergence of central sleep apnea has been reported after treating sleep apnea with UAS. 20 This phenomenon is known to occur with existing sleep apnea therapies, including CPAP, mandibular advanced devices (MADs), and upper airway surgery. [21][22][23] Treatment-emergent central sleep apnea (CSA) is the appearance of central apneas and hypopneas after significant resolution of the obstructive events has been achieved with therapy.…”