Abstract
Introduction: We hypothesized that individual differences in the pathophysiological traits of obstructive sleep apnea (OSA) influence the efficacy of respiration-synchronized stimulation of the hypoglossal nerve with upper airway stimulation (UAS) therapy. Aims and objectives: We assessed whether patients with greater baseline collapsibility, lower arousal threshold, and/or higher loop gain exhibited the most residual events on UAS therapy. Methods: Polysomnographic (PSG) recordings at baseline and after 12 months of treatment were examined. Pathophysiological traits were estimated from the baseline PSG according to Sands SA et al. AJRCCM 2018. Multivariate regression, adjusting for baseline apnea/hypopnea index (AHI), was used to combine the traits to predict the residual AHI on treatment. Results: Eleven patients including both responders and non-responders have been studied to date. Overall, AHI fell from 37±10/h to 27±12/h (p=0.07, mean±SD) and apnea index (AI) from 14±8/h to 6±5/h (p=0.01). We found no strong univariate predictor of treatment AHI (trends: higher loop gain R=0.32, lower arousal threshold R=-0.29). Multivariate analysis yielded borderline associations with treatment AHI (higher loop gain: β=+7.5±4.5/h, p=0.1; lower arousal threshold: β=-9.6±5.5/h, p=0.1; greater collapsibility: β=+8.0±5.8/h, p=0.2; β±SEM indicates residual AHI per 1 SD increase in trait (strength); total trait ΔR2=0.37 after adjusting for baseline AHI). Conclusions: These preliminary results indicate a probable role for greater ventilatory control instability, greater respiratory arousability, and a more collapsible upper airway as causes of incomplete OSA treatment with UAS.
Published Version
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