Effect of Gender, Age, and Profound Disease on Upper Airway Stimulation Outcomes

Abstract

<jats:sec><jats:title>Objective:</jats:title><jats:p> To evaluate treatment outcomes of upper airway stimulation (UAS) in obstructive sleep apnea (OSA) patients based on patient age, gender, and preoperative disease severity. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Retrospective chart review of patients undergoing UAS from 2014 to 2018 at a tertiary care center. Data collected included demographic information, implantation records, and pre- and postoperative polysomnography (PSG) results. Profound OSA was defined as AHI &gt;65 and age ≥65 was considered advanced age. The primary outcome measured was initial treatment response, defined as a post-operative AHI &lt;20 with a &gt;50% reduction from baseline. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 145 patients underwent UAS at our institution including 98 males and 47 females with a mean age of 61.7 ± 11.5 years, mean BMI of 29.1 ± 3.9 kg/m<jats:sup>2</jats:sup>, and mean preoperative AHI of 34.1 ± 18.2 events/hour. After surgery, patients had a significantly lower mean AHI of 8.6 ± 15.0 events/hour (&lt;0.001). Older patients had a lower initial treatment response rate (78%) when compared to their younger counterparts (94%) ( P = 0.005). Male gender and profound disease status did not significantly impact treatment response rates; young age was the only variable found to predict early treatment response on multivariate analysis ( P = 0.003). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Although the overall OSA population showed significant postoperative AHI reduction with UAS, patients age ≥65 years were less likely to have an initial response to treatment, when compared to their younger counterparts. A larger proportion of elderly patients and patients with profound OSA had residual moderate disease (AHI &gt; 15) after UAS. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> 4 </jats:p></jats:sec>

Improving outcomes of hypoglossal nerve stimulation therapy: current practice, future directions, and research gaps. Proceedings of the 2019 International Sleep Surgery Society Research Forum

“…In the study of predictors of treatment effectiveness in the ADHERE registry, for every 1 year increase in age there was a 4% increase in odds of treatment success. 37 On the other hand, in the previously quoted study by Patel et al, 49 patients above the age of 65 years had a decreased treatment response compared to their younger counterparts. Certainly, further study is warranted with regard to the ideal age for implantation.…”

“…37 Another study by Patel et al found that sex did not influence outcomes. 49 However, in the latest update of the ADHERE registry study, which included 1017 HGNS patients, female sex appeared as a significant predictor of therapy response. 50 It should be noted that given the limited morbidity associated with this therapy, HGNS may represent a very reasonable option for consideration in the aging population.…”

Hypoglossal Nerve Stimulation Effects on Obstructive Sleep Apnea Over Time: A Systematic Review and Meta‐analysis

“…Pretreatment measurements were defined as polysomnography outcomes and quality of life scores obtained before HGS. Outcomes analyzed during the 12‐month postoperative period included polysomnography parameters and disease‐specific quality of life scores 18‐63 . Comparisons between pretreatment and posttreatment values were analyzed during the follow‐up period.…”