0479 Prevalence, Clinical Features, and Impact of Low Respiratory Arousal Threshold on Patients with Hypoglossal Nerve Stimulation

Abstract

Abstract Introduction This study aims to explore the prevalence and clinical features associated with low respiratory arousal threshold (ArTH) amongst patients with hypoglossal nerve stimulation (HNS) for the treatment of obstructive sleep apnea (OSA) and the possible effects it has on HNS adherence and device usage between time of activation and 1-year post-activation. Methods Following institutional review board approval, consecutive patients who underwent HNS system implantation were retrospectively studied, including clinical characteristics, diagnostic polysomnography (PSG) or homes sleep apnea test (HSAT) and HNS post-implant data. Inclusion criteria were patients with ≥1 year of HNS usage who had also completed a post-implant HNS PSG titration study. Results Forty-five patients met inclusion criteria. Low ArTH was present in 44.4% of patients and compared to those with high ArTH, low ArTH had a higher prevalence of restless leg syndrome (RLS) (45% vs 12%, p< 0.05) and depression (60% vs 28%, p< 0.05). Low ArTH exhibited a trend toward shorter diagnostic total sleep time (TST) (295.0 vs 373.3 minutes, 0.05 < p < 0.1). Bivalent logistic regression indicated the odds of having low ArTH is 8.6 times greater in patients with RLS (OR 8.6, CI 1.1 – 68.6, p< 0.05). Across all time points, low ArTH resulted in lower mean percentage of HNS nights used (92% vs 86%, p< 0.001) and a lower HNS amplitude (2.41 V vs 1.96 V, p< 0.001) and demonstrated a trend towards lower percentage of nights used ≥4 hours (72.9% vs 66.1%, 0.05 < p < 0.1). 1-year post activation, low ArTH patients continued to show lower percentage of HNS nights used (89.8% vs 75.6%, p< 0.01) and a lower HNS amplitude (2.3 V vs 1.9 V, p< 0.01). Conclusion Low ArTH was highly prevalent amongst patients with OSA treated with HNS and was more frequently associated in patients with RLS. Patients with a low ArTH demonstrated significantly lower percentage of nights used and lower amplitudes, indicating the importance this particular phenotype may play in patient compliance with HNS. These findings could help better select candidates who will tolerate HNS therapy and develop targeted therapies to improve long-term adherence. Support (if any)