Premium
Inclusion of the first cervical nerve does not influence outcomes in upper airway stimulation for treatment of obstructive sleep apnea
Author(s) -
Kumar Ayan T.,
Vasconcellos Adam,
Boon Maurits,
Huntley Colin
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28256
Subject(s) - medicine , obstructive sleep apnea , epworth sleepiness scale , polysomnography , cuff , anesthesia , stimulation , nadir , airway , body mass index , tongue , hypoglossal nerve , prospective cohort study , apnea , surgery , satellite , pathology , engineering , aerospace engineering
Objectives/Hypothesis Upper airway stimulation (UAS) has demonstrated efficacy in the management of obstructive sleep apnea (OSA). Branches of the hypoglossal nerve that selectively activate tongue protrusor and stiffener muscles are included within the stimulation cuff electrode. The first cervical nerve (C1) is often also included to stimulate additional muscles contributing to tongue protrusion and stabilization. The purpose of this study was to determine whether inclusion of the C1 translates into treatment efficacy, decreased voltage requirement, and improved outcomes in patients utilizing UAS. Study Design Single‐center, retrospective cohort study. Methods One hundred fourteen patients who received a UAS implant at our institution and underwent posttreatment polysomnography were evaluated. Stimulation cuff electrodes in 87 patients included the C1; those in the remaining 27 patients did not include the C1. Demographic data, voltage data, and pre‐ and posttreatment apnea‐hypopnea index (AHI), O 2 nadir, and Epworth Sleepiness Scale (ESS) data were collected for all patients. Results There was no significant difference in stimulation voltage, or posttreatment AHI, O 2 nadir, and ESS between the two cohorts. Treatment success, as measured by posttreatment AHI < 20 with a 50% reduction, was similar regardless of C1 inclusion. The same was seen for the percent of patients with AHI < 15 and AHI < 5 after treatment. The distributions of age and body mass index, as well as pre‐treatment AHI, O 2 nadir, and ESS were also not significantly different between treatment groups. Conclusions The current study has demonstrated that inclusion of the C1 in the stimulation cuff electrode of the upper airway stimulator may not provide any additional benefit in therapy for OSA. Level of Evidence 4 Laryngoscope , 130:E382–E385, 2020