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Transoral Versus Endoscopic Examination in Predicting Outcomes of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
Author(s) -
Lee Clara H.,
Mulholland Graeme B.,
Dedhia Raj C.
Publication year - 2021
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.28779
Subject(s) - medicine , tongue , hypoglossal nerve , otorhinolaryngology , genioglossus , obstructive sleep apnea , retrospective cohort study , cohort , endoscopy , surgery , anesthesia , pathology
Objectives/Hypothesis To examine the correlation between transoral and awake endoscopic examination and investigate their respective ability to predict outcomes of hypoglossal nerve stimulation (HGNS). Study Design Retrospective cohort study at a US medical center. Methods Subjects were adults with apnea‐hypopnea index (AHI) >15 events/hr who underwent HGNS according to standard indications. Eligible subjects had diagnostic preoperative sleep studies, full‐night efficacy postoperative studies, as well as postoperative video recordings of transoral examination and awake endoscopy. Recordings were independently scored by two blinded reviewers. Cohen's κ coefficient, Student t test, and χ 2 analyses were performed. Results Fifty‐seven patients met all inclusion criteria. On average, patients were Caucasian, middle aged, and overweight. The mean preoperative AHI was 36.7 events/hr, which improved significantly to 18.3 events/hr following HGNS ( P < .01). Overall, the response rate (defined as AHI reduction >50% and AHI < 20 events/hr) was 49%. There was slight correlation between transoral tongue protrusion and endoscopic tongue base movement (κ = 0.10). On transoral examination, patients with minimal/moderate tongue motion achieved a greater mean AHI reduction than patients with full motion (26.0 ± 18.0 vs. 12.8 ± 24.1, P = .02). In contrast, on awake endoscopy, patients with minimal/moderate tongue motion achieved a lesser mean AHI reduction than patients with full motion (8.7 ± 19.9 vs. 22.1 ± 22.7, P = .04). Conclusions Transoral tongue protrusion bears an inverse relationship to HGNS success and correlates poorly with endoscopic tongue base movement. Endoscopic tongue base motion appears reflective of response to HGNS, with greater motion corresponding to greater AHI reduction. Level of Evidence 4 Laryngoscope , 131:675–679, 2021