Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable?

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Upper airway stimulation (UAS) is an effective treatment for obstructive sleep apnea (OSA) after positive airway pressure (PAP) therapy failure.
• Closed-loop hypoglossal nerve implants for UAS require the absence of complete concentric collapse of the palate during sleep endoscopy.
• The prevalence and predictors of palatal concentric collapse as an exclusion criterion for UAS are not well-established.

Purpose of the Study:

• To determine the frequency of concentric palatal collapse during sleep endoscopy in patients seeking alternatives to PAP therapy.
• To investigate the influence of sleep apnea severity and anthropometric characteristics as predictors of concentric palatal collapse.

Main Methods:

• A prospective study of 74 consecutive patients with sleep apnea evaluated over 2 years.
• Sleep endoscopy performed under propofol anesthesia to assess airway collapse.
• Statistical analysis to identify predictors of concentric collapse, including body mass index (BMI) and apnea-hypopnea index (AHI).

Main Results:

• One-fifth of patients exhibited concentric palatal collapse.
• Higher BMI and AHI values were significant predictors of concentric collapse (p=0.011, p=0.026).
• While BMI thresholds (32-35 kg/m²) showed moderate specificity for predicting collapse, a notable number of severely overweight patients did not have concentric collapse.

Conclusions:

• Concentric palatal collapse is a frequent finding during sleep endoscopy for patients considering PAP alternatives.
• Anthropometric data and sleep assessments alone are insufficient to reliably predict concentric collapse.
• Sleep surgeons must consider the possibility of concentric collapse, particularly in overweight patients with severe OSA, and utilize sleep endoscopy for informed treatment decisions.