Comparative Efficacy of Patients with OSA Undergoing Multi-level Surgery followed by Upper Airway Stimulation vs. Isolated Upper Airway Stimulation

Abstract

PurposeUpper airway stimulation (UAS) via hypoglossal nerve stimulation is a viable management option for patients with obstructive sleep apnea (OSA). Important exclusion criteria for the current UAS protocol include AHI above 65 events per hour or concentric collapse of the velum seen on drug-induced sedation endoscopy (DISE). The authors describe the treatment efficacy of a cohort of UAS patients who were initially ineligible, but who were implanted following multilevel surgery that reversed the exclusion criteria. MethodsThe design in a single-center, retrospective study. Data collection included demographics, body-mass index (BMI), apnea-hypopnea index (AHI) titration results, oxygen desaturation index (ODI), Drug Induced Sedation Endoscopy (DISE) results, Epworth sleepiness score (ESS), and Fatigue Severity Score (FSS). ResultsThirty-six subjects underwent UAS implantation (Inspire system, MN, USA) from 2016 to 2019. Eighteen subjects who were initially ineligible for UAS first underwent multi-level surgery, including uvulopalatopharyngoplasty (UPPP), genioglossus advancement (GGA), distraction osteogenesis maxillary expansion (DOME), or maxillomandibular advancement (MMA). Mean subject age was 62.3±9 years with 28% being female. Mean subject BMI was 29±4kg/m2. Seventeen subjects met the criteria for UAS and underwent surgery. Mean subject age was 62.9±14 years with 12% being female. Mean subject BMI was 26.7±4kg/m2. Mean pre-treatment AHI for 2-staged patients was 49±29 events per hour, which was reduced to 3.6±5 events per hour with an average voltage of 1.8V±0.9. Mean pre-treatment AHI for UAS-only cohort was reduced from 33±14 events per hour to 5.3±6 events per hour with an average voltage of 1.9V±0.3. ConclusionFor patients who are ineligible for UAS due to severity of OSA or concentric collapse of the velum, multilevel surgery including UPPP, GGA, DOME, or MMA followed by UAS confers reliable, effective, and equitable post-treatment results.