1243 A Guinness Book Challenge in Upper Airway Stimulation Activation

Abstract

Abstract Introduction Upper airway stimulation is a option for CPAP-intolerant patients. Device activation is typically ~4 weeks after the implant procedure. Report of Case A 61yo male with severe OSA had an upper airway stimulation device placed by ENT. At that time, stimulation produced bilateral tongue protrusion. In the immediate post-operative period, after closure, a hematoma, at the inferior chest incision, was discovered and drained with cauterization of the bleeding vessel. Seven weeks after implant, patient reported to our sleep clinic for activation of the device; and at that time, there was no sensation or activation up to the maximum amplitude of 5mV. The device reported an acceptable respiratory waveform, and triggering on and off sets but without sensory outcomes. Changing of the electrode configuration with advanced settings had no effect. Impedance values were acceptable. Tongue movements were grossly intact. At 2 months, ENT evaluation found mild hypoglossal nerve neuropraxia. To assess for a device related issue, x-rays of the neck and chest were performed and showed proper placement of the device. At 3.5 months, neuropraxia had resolved but device activation was unsuccessful, with no sensory or motor activation to 5mV stimulation. Plans were made for a procedure during which the lead electrode or implantable pulse generator would be assessed or replaced. At 4 months after implantation, in a multidisciplinary appointment with Sleep, ENT and the device representative, with a 3 electrode negative pole and the generator as the + pole, at 2.3mV, the device was activated. At the present time, the patient is exploring higher and lower mV settings and a PSG titration is scheduled. Conclusion This is the longest recorded duration (3.5+ months) of unsuccessful post-operative activation; and it occurred ~2 months after clinical signs of hypoglossal nerve neuropraxia had resolved.