Outcomes of Hypoglossal Nerve Upper Airway Stimulation among Patients with Isolated Retropalatal Collapse

• Published in: Otolaryngology-head and neck surgery 2019-06, Vol.160 (6), p.1124-1129
• Main Authors: Mahmoud, Ahmad F., Thaler, Erica R.
• Format: Article
• Language: English
• Subjects: Aged; Airway Obstruction - etiology; Airway Obstruction - therapy; apnea hypopnea index; Electric Stimulation Therapy; Endoscopy; Female; Humans; Hypoglossal Nerve; hypoglossal nerve stimulator; Implantable Neurostimulators; Inspire implant; Male; Middle Aged; obstructive sleep apnea; OSA; oxyhemoglobin saturation; Palate, Soft; retropalatal collapse; Retrospective Studies; Sleep Apnea, Obstructive - etiology; Sleep Apnea, Obstructive - therapy; Treatment Outcome; UAS; upper airway stimulation
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599819835186

Objective To examine whether patients with isolated retropalatal collapse perform as well as others following implantation with an upper airway stimulation (UAS) device. Study Design Retrospective review. Setting Single-institution tertiary academic care medical center. Subjects and Methods Following drug-induced sleep endoscopy, subjects who met inclusion criteria for implantation with a UAS device received an implant per industry standard. Subjects with isolated retropalatal collapse were compared with those having other patterns of collapse. Outcome measures included apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (NOS). Results Ninety-one patients were implanted during the duration of the study, and 82 met inclusion criteria for analysis. Twenty-five had isolated retropalatal collapse, while the remaining 57 had other patterns of collapse on drug-induced sleep endoscopy. For all patients, mean preoperative AHI and NOS were 38.7 (95% CI, 35.0-42.4) and 78% (95% CI, 75%-80%), respectively; these improved postoperatively to 4.5 (95% CI, 2.3-6.6) and 91% (95% CI, 91%-92%). There was no significant preoperative difference between groups with regard to demographics, AHI, or NOS. Group comparison showed postoperative AHI to be 5.7 (95% CI, 0.57-10.8) for patients with isolated retropalatal collapse and 3.9 (95% CI, 1.7-6.1) for other patients (P = .888). Postoperative NOS was 92% (95% CI, 90%-94%) among patients with isolated retropalatal collapse and 91% (95% CI, 90%-92%) for others (P = .402). Conclusions All patients showed significant improvement following implantation with UAS. Patients with isolated retropalatal collapse showed similar improvement to other types of collapse with regard to AHI and NOS.