Upper Airway Stimulation Effective for OSA in Patients with Prior Airway Surgery

by ENTtoday •

How will patients with obstructive sleep apnea (OSA) and surgically altered airway anatomy respond to upper airway stimulation (UAS) as compared with surgically naïve individuals?

Bottom line
UAS resulted in significant and profound improvement for all groups. Additionally, this study demonstrated no significant difference between outcomes for patients with prior airway surgery and those without.

Background: Soft tissue collapse of the upper airway is a hallmark of OSA. Neurostimulation aims to solve this problem by inducing tone in key muscles in the upper aerodigestive tract in order to maintain patency of the airway without voluntary intent from the patient, and has been demonstrated mechanistically in multiple animal models. It is clear that upper airway stimulation works, particularly for a large subset of patients with favorable patterns of airway collapse. What is poorly understood, however, is how patients with surgically altered airway anatomy will respond to UAS as compared to surgically naïve individuals.

Study design: Retrospective chart review at a single institution tertiary academic care center.

Setting: Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia.

Synopsis: Following implantation with hypoglossal nerve stimulator device, the outcomes of patients who underwent prior airway surgery for OSA were compared with those who did not. Primary outcome measures included apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (NOS) as measured by polysomnography. Secondary outcome measures included Epworth Sleepiness Scale.

Forty-seven patients underwent implantation with hypoglossal nerve stimulator. Of these, 30 patients had undergone prior airway surgery for OSA, whereas 16 had not. Mean preoperative AHI and NOS were 39.3 ± 2.8 and 78% ± 1.8% for all patients, 39.4 ± 3.7 and 79% ± 14% for patients with prior airway surgery, and 39.1 ± 4.0 and 77% ± 2.6% for patients without prior surgery. Mean postoperative AHI and NOS were 3.9 ± 1.2 and 91% ± 0.4% for all patients, 4.2 ± 1.7 and 91% ± 0.5% for patients with prior surgery, and 3.4 ± 1.5 and 93% ± 0.6% for patients without prior surgery.

Citation: Mahmoud AF, Thaler ER. Upper airway stimulation therapy and prior airway surgery for obstructive sleep apnea. Laryngoscope. 2018;128: 1486–1489.