Hypopharyngeal Options for OSA

by Thomas R. Collins •

At three years, 98 patients from the pivotal Stimulation Therapy for Apnea Reduction (STAR) trial on the Inspire device underwent an optional repeat sleep study (N Engl J Med. 2014;370:139–149). The overall apnea-hypopnea index (AHI) was 6.2 in these patients. “It shows that this device is still quite effective on average in this group of patients,” Dr. Gillespie said. At 48 months, 85% of patients were still reporting soft snoring or no snoring, he said.

A competing device from ImThera Medical is now in a phase 3 trial, Dr. Gillespie said. “It’s a much simpler design, it’s an easier surgery, [and] it takes about 45 minutes to do,” he said. “It’s a small device. So it will be interesting to see the outcomes of that.”

He noted that evaluation of patients with drug-induced sleep endoscopy (DISE) was a requirement in the Inspire trial but is not required for the ImThera device. Whether or not DISE should be used in evaluation patients before upper airway stimulation, he said, is “a question that needs to be answered.”

TORS

Erica Thaler, MD, professor of otorhinolaryngology-head and neck surgery at the University of Pennsylvania in Philadelphia, said that while she’s been using more upper airway stimulation lately, TORS remains “an important thing to consider and an important part of surgical management.”

In her cases, TORS patients who have not undergone prior surgery have experienced a 67% reduction in AHI, which is approximately double the rate seen in patients treated with UPPP alone (Laryngoscope. 2016;126:266–269).

Dr. Thaler suggested waiting long enough during an evaluation to notice what is happening with the epiglottis. Approximately 10% to 15% of the time, there will be collapse. Anterior-posterior collapse, as opposed to lateral to medial collapse, is harder to address and should be dealt with during the surgery, she said.

“One of the things that I’ve learned, as I’ve done it more with DISE, is that I’ve paid more attention to the epiglottis.”

Thomas Collins is a freelance medical writer based in Florida.

Take-Home Points

  • GTA for hypopharyngeal collapse shouldn’t be avoided out of concern over complication rate; the rate is low.
  • Three-year data show persistent success for upper airway stimulation.
  • Assessment of the epiglottis during DISE is worthwhile before TORS procedures.