Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

Steffen, Armin; Abrams, N; Suurna, Maria V.; Wollenberg, Barbara; Hasselbacher, K

doi:10.1002/lary.27357

Cited by 32 publications

(22 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…53,54 Another retrospective analysis found no indication for patients to routinely undergo UPPP before HNS, while palatal surgery could be suggested in case of non-adequate response to HNS after the implantation. 55 Accordingly, a recent study based on the Adhere Registry data (n = 299) showed that previous surgery is not associated with HNS outcomes. 52 In addition to previously described predictors, frequently used exclusion criteria are: more than 25% of central sleep apneas; positional OSA (>50% reduction in AHI between supine and non-supine positions); tonsil size greater than type 2; tongue malformations; alteration of tongue motor activity; marked salivation disorders; neuromuscular disease; hypoglossal-nerve palsy; active psychiatric disease; other non-respiratory sleep disorders; pregnancy; major systemic disorder; requirement of magnetic resonance imaging.…”

Section: Patient Selection and Efficacy Predictorsmentioning

confidence: 99%

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Baptista¹,

Costantino²,

Moffa³

et al. 2020

NSS

View full text Add to dashboard Cite

Hypoglossal nerve stimulation (HNS) is an increasingly widespread OSA treatment. It is a non-anatomical modifying surgery able to achieve an adequate objective and subjective result with a reasonable complication rate. HNS exploits the neurostimulation to reduce upper airway collapsibility providing a multilevel upper airway improvement within a single procedure. Proper patient selection has a fundamental role in determining an adequate long-term clinical outcome. All patient candidates for HNS undergo a standard comprehensive sleep medicine assessment and upper airway surgical examination. Several features should be assessed preoperatively in order to predict patients' response to HNS treatment. In particular, the assessment of OSA severity, BMI > 32 Kg/m 2 , collapse pattern during drug-induced sleep endoscopy (DISE), and many other parameters, is central for a good patient selection and customization of OSA treatment. HNS is indeed one of the most promising tools in the widespread context of personalized sleep medicine. HNS is an adjustable medical device that could be titrated in order to improve HNS effectiveness, maintaining patient comfort. Moreover, HNS provides the opportunity for patients to play an active role in their own care, with a potential improvement in therapy adherence and efficacy. This review summarizes the current evidence in patient selection for HNS, highlighting the reasons behind the optimistic future of this OSA treatment in the context of personalized medicine.

show abstract

Section: Patient Selection and Efficacy Predictorsmentioning

confidence: 99%

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Baptista¹,

Costantino²,

Moffa³

et al. 2020

NSS

View full text Add to dashboard Cite

show abstract

“…106 A combination of UPPP and hypoglossal nerve stimulation might also be beneficial. 107 Hypoglossal nerve stimulation has not been introduced in Sweden.…”

Section: Hypoglossal Nerve Stimulationmentioning

confidence: 99%

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

et al. 2020

View full text Add to dashboard Cite

Uvulopalatopharyngoplasty (UPPP) is the most common surgical treatment for adult patients with obstructive sleep apnea (OSA). Its short-term efficacy, as measured through polysomnography, is well-established and has been demonstrated in two randomized controlled trials in recent years. However, less is known about subjective sleep quality, longterm efficacy, and side effects after surgery. In addition, the reliability of the most widespread clinical test for selecting patients for surgery-the Friedman staging system-is unclear. The Friedman staging system uses a combination of tonsil size and tongue position to predict the likelihood of successful surgery. The objective of studies I and II was to evaluate the staging system by determining its inter-examiner agreement. In study I, 15 doctors evaluated the system by using it on each other. In study II, 14 doctors evaluated the system by using it on 12 patients with OSA. Cohen's kappa analysis was used. Kappa values of 1 represents perfect agreement, and values of 0 represent no more agreement than would have been expected through random chance. In study I, the median kappa was 0.36 for tongue position. In study II, the median kappa was 0.32 for tongue position, 0.62 for tonsil size, and 0.38 for the Friedman staging system. These findings correspond to poor agreement, indicating that the system is an uncertain method for selecting patients for UPPP. Uvulopalatopharyngoplasty was first described in the eighties. Since then, there has been several modifications. The modified UPPP used in this thesis includes a tonsillectomy and is performed with cold instruments. It is less radical to the palate compared to the original procedure. The objective of study III was to investigate whether modified UPPP improves sleep quality by using the Functional Outcomes of Sleep Questionnaire and the Karolinska Sleep Questionnaire. The study consisted of two parts: Part 1 was a randomized controlled trial with two study groups (intervention and controls), and Part 2 was a post-operative follow-up of all patients (intervention and controls who received delayed surgery) with an analysis of outcomes at six and 24 months after UPPP. In eight out of nine subscales, there were significant improvements between the intervention and controls in favor of UPPP. In addition, at the six-and 24-month post-operative follow-ups of all patients, eight out of nine subscales were significantly improved compared to the baseline. These findings suggest a real and lasting beneficial effect of UPPP on subjective sleep quality, although a placebo effect cannot be excluded.

show abstract

“…This includes encouragement for increased therapy usage or voltage, repeated HST or PSG, or DISE with stimulation 13 to optimize electrode configurations or identify persistent obstruction sites, such as the soft palate. 11 It is also our center's experience that recommending weight-loss programs is effective for overweight patients with persistent OSA problems. 4.…”

Section: Discussionmentioning

confidence: 99%

“…In some isolated cases, additional upper airway surgery was performed. [10][11][12][13] This study attempted to show that our center's approach of using HSTs for the initial sUAS evaluation would be similar to results using PSG titration at the M6, M12, or M24 evaluations.…”

Section: Introductionmentioning

confidence: 99%

Home Sleep Testing to Direct Upper Airway Stimulation Therapy Optimization for Sleep Apnea

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objectives/Hypothesis: Selective upper airway stimulation (sUAS) is a well-established treatment option for obstructive sleep apnea (OSA). This study aimed to determine if there are benefits in performing a home sleep test (HST) to evaluate postoperative sUAS effectiveness after patient acclimatization compared to the generally used polysomnography (PSG) titration, as measured by long-term follow-up outcomes. Study Design: Retrospective comparative cohort analysis. Methods: We conducted an analysis of consecutive patients at our center who had completed a 6-month follow-up (month 6 [M6]) and recorded data from M6, month 12 (M12), and month 24 (M24). After device activation, we performed an HST with the patient's stimulation settings, and measured the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and device usage. These values were compared to patients who had undergone PSG-based device titration. Results: Baseline values of the initial 131 patients show high ESS and moderate OSA. At the 2-month time point of the HST, nearly half of the patients (46.2%) reached an AHI ≤15/hr, and approximately a fifth (19.2%) reached <5/hr. The PSG and HST groups differed in median ESS at M24, but no other differences were observed for ESS at M6 and M12. Both groups showed similar AHI, oxygen desaturation, and usage hours per week. Conclusions: Adjusting therapy by using the HST technique after device activation and acclimatization has clinical and economic advantages. These advantages are contingent on several conditions being met when deviating from the standard device protocol, including precise communication with the referring sleep medicine physicians, especially their role in helping with long-term follow-up.

show abstract

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

Cited by 32 publications

References 28 publications

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

<p>Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea: Patient Selection and New Perspectives</p>

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Home Sleep Testing to Direct Upper Airway Stimulation Therapy Optimization for Sleep Apnea

Contact Info

Product

Resources

About