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Success of Hypoglossal Nerve Stimulation Using Mandibular Advancement During Sleep Endoscopy
Author(s) -
Mulholland Graeme B.,
Dedhia Raj C.
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.28589
Subject(s) - medicine , polysomnography , obstructive sleep apnea , body mass index , confidence interval , apnea , hypoglossal nerve , anesthesia , hypopnea , airway , tongue , pathology
Objectives/Hypothesis Hypoglossal nerve stimulation (HGNS) effectively treats obstructive sleep apnea in select patients. Drug‐induced sleep endoscopy (DISE) is required for HGNS candidacy. Data suggest that mandibular advancement (MA) devices and HGNS share similar target populations. We aimed to test the association between MA's effect on the velum and lateral walls during DISE in relation to the improvement in the apnea‐hypopnea index (AHI) with HGNS. Study Design Prospective case series Methods All patients completed preoperative polysomnography or home sleep study, DISE with MA prior to HGNS implantation, and full‐night efficacy sleep tests. Adult patients with body mass index (BMI) ≤ 35 and AHI ≥ 15 were included. Two independent reviewers scored DISE videos. Results Forty‐six patients were included from October 2015 to January 2019. Mean BMI (standard deviation) was 28.5 (3.7) kg/m 2 . Patients with a reduced airway response to MA had greater AHI improvement than patients with a robust response (21.7, 95% confidence interval [CI]: 14.4 to 29.0 vs. 4.9, 95% CI: −8.9 to 18.6; P = .03). Patients with complete baseline collapse at the velum and lateral walls (n = 11) had less response compared to those with partial collapse (n = 35) (AHI reduction of 4.4 [95% CI: −8.6 to 17.4] vs. 22.3 [95% CI: 15.1 to 29.6; P = .02]). Conclusions Patients having significant airway improvement in the upper pharynx with MA during DISE appear less likely to succeed with HGNS. This phenomenon might be secondary to the worsened baseline obstruction of the upper pharynx in such patients. Level of Evidence 4 Laryngoscope , 2020