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Evaluation of Therapeutic Positive Airway Pressure as a Hypoglossal Nerve Stimulation Predictor in Patients with Obstructive Sleep Apnea

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dc.contributor.author Dedhia, R.C.
dc.contributor.author Seay, E.G.
dc.contributor.author Keenan, B.T.
dc.contributor.author Schwartz, A.R.
dc.date.accessioned 2020-12-14T16:06:19Z
dc.date.available 2020-12-14T16:06:19Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8696
dc.description.abstract Importance: Recent retrospective hypoglossal nerve stimulation (HGNS) outcomes data suggest that patients with low therapeutic positive airway pressure (PAP) levels achieve greater success than patients with high therapeutic PAP levels. Objective: To examine the use of therapeutic nasal PAP levels at the soft palate in predicting the outcomes of HGNS for patients with obstructive sleep apnea. Design, Setting, and Participants: This prospective cohort study used drug-induced sleep endoscopy (DISE) to evaluate the predictive capacity of therapeutic PAP levels in HGNS outcomes. In an academic sleep surgery center, 27 consecutive patients with obstructive sleep apnea who underwent DISE before implantation of an HGNS device were evaluated. The study was conducted from May 1, 2018, to June 26, 2019. Exposures: Positive airway pressure delivered through a nasal mask during DISE. Main Outcomes and Measures: Improvement in apnea-hypopnea index as measured from full-night preoperative and postoperative efficacy studies. Results: Twenty-seven patients met all inclusion criteria. The mean (SD) age was 62.0 (14.4) years, 14 participants were men (51.9%), and mean body mass index was 28.1 (4.0). Responders to HGNS therapy (n = 18) had significantly lower mean (SD) palatal opening pressure compared with nonresponders (n = 9) (5.0 [2.8] vs 9.2 [3.7] cm H2O, respectively; mean difference, -4.2; 95% CI, -6.8 to -1.6 cm H2O). After adjusting for age, sex, and body mass index, the mean palatal opening pressure value for the responders remained 3.5 cm H2O lower (95% CI, -6.7 to -0.4 cm H2O) than that of nonresponders. A palatal opening pressure cutoff level less than 8 cm H2O demonstrated a positive predictive value of 82.4%; sensitivity, 77.8%; and specificity, 66.7%. Conclusions and Relevance: In this small prospective cohort study, therapeutic nasal PAP levels during DISE differed significantly between responder and nonresponders to HGNS. Because DISE represents a mandatory, relatively standardized diagnostic tool for HGNS candidacy, the use of therapeutic nasal PAP through DISE can be broadly implemented and studied across multiple centers to possibly improve patient selection for HGNS. en_US
dc.language.iso eng
dc.publisher American Medical Association
dc.relation.ispartof urn:issn:2168-619X
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject UNAVAILABLE en_US
dc.title Evaluation of Therapeutic Positive Airway Pressure as a Hypoglossal Nerve Stimulation Predictor in Patients with Obstructive Sleep Apnea en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1001/jamaoto.2020.1018
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE


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