Evaluation of In-Office Volitional Snore as a Screening Tool for Candidacy for Hypoglossal Nerve Stimulation

• Published in: Otolaryngology-head and neck surgery 2022-03, Vol.166 (3), p.595-597
• Main Authors: Yalamanchi, Pratyusha, Mott, Nicole, Ali, Syed Ahmed, Peddireddy, Nithin S., Kovatch, Kevin J., Stanley, Jeffrey J., Hoff, Paul T.
• Format: Article
• Language: English
• Subjects: Adult; Continuous Positive Airway Pressure; drug‐induced sleep endoscopy; Endoscopy; Humans; Hypoglossal Nerve; obstructive sleep apnea; Polysomnography; Sleep; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; sleep surgery; sleep‐disordered breathing; Snoring; upper airway stimulation
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/01945998211023733

Candidacy evaluation for hypoglossal nerve stimulation (HGNS) is resource intensive. This proof-of-concept study investigates use of in-office volitional snore during flexible laryngoscopy as an efficient, cost-effective screening tool for HGNS evaluation. Adults with moderate to severe obstructive sleep apnea that failed continuous positive airway pressure treatment (n = 41) underwent evaluation for HGNS from 2018 to 2019. Volitional snore and drug-induced sleep endoscopy (DISE) data were collected and scored by VOTE classification (velum/palate, oropharynx, tongue base, epiglottis). A chi-square test of independence was performed that demonstrated a significant relationship between volitional snore and DISE (χ2 = 4.39, P = .036) for velum collapse pattern. Sensitivity and specificity of volitional snore for detecting velum collapse pattern were 93.6% (95% CI, 75.6%-99.2%) and 40% (95% CI, 12.2%-73.8%), respectively, illustrating its utility in screening for HGNS. Patients who demonstrate anterior-posterior velum collapse on volitional snore may be excellent candidates for confirmatory DISE at the time of HGNS implantation.