Flow-shape-derived Site of Pharyngeal Collapse Predicts Response to Hypoglossal Nerve Stimulation Therapy

Vena, Daniel; Huyett, Phillip; Beeck, Sara Op de; Yang, Hyun‐Sik; Wang, T.-Y.; Calianese, N.; Sumner, J.; Azarbarzin, Ali; Gell, L.; Messineo, Ludovico; Labarca, G.P.; White, David P.; Sands, S.A.; Wellman, Andrew

doi:10.1164/ajrccm-conference.2023.207.1_meetingabstracts.a6271

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“…For example, patients interested in hypoglossal nerve stimulation could be counselled on their preference based on whether they have a high or low CCCp likelihood detected before proceeding with DISE. While preliminary work appears promising for treatment response prediction [ 24 – 26 ], further studies are needed to demonstrate clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy

Op de Beeck,

Vena,

Mann

et al. 2024

Eur Respir J

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RationaleDifferences in the pharyngeal site-of-collapse influences efficacy of non-CPAP therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site-of-collapse using overnight polysomnography.Methods182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow-shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, N=44/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (N=22)versusabsence (N=128) of CCCp (partial collapse and concurrent tongue-base collapse excluded). Odds ratios for actual CCCp between predicted subgroups were quantified after cross-validation. Secondary analyses examined complete lateral wall, tongue-base, or epiglottis collapse. External validation was performed on a separate dataset (Ntotal=466).ResultsCCCp was characterised by greater scoopiness (β=1.5±0.6 per 2SD, multivariable estimate±se) and skewness (β=11.4±2.4) compared to non-CCCp. Odds ratio [95%CI] for CCCp in predicted positiveversusnegative subgroups was 5.0[1.9–13.1]. The same characteristics provided significant cross-validated prediction of lateral wall (OR=6.3[2.4–16.5]), tongue-base (3.2[1.4–7.3]), and epiglottis (4.4[1.5–12.4]) collapse. CCCp and lateral wall collapse shared similar characteristics (skewed, scoopy), diametrically opposed to tongue-base and epiglottis collapse characteristics. External validation confirmed model prediction.ConclusionsThe current study provides a means to recognise patients with likely CCCp or other DISE-based site-of-collapse categories using routine polysomnography. Since site-of-collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.

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Section: Discussionmentioning

confidence: 99%