Palatal Coupling Maneuvers Do Not Predict Hypoglossal Nerve Stimulator Treatment Efficacy

Area of Science:

• Sleep Medicine
• Otolaryngology
• Medical Devices

Background:

• Obstructive sleep apnea (OSA) affects millions globally, often treated with oral appliances or hypoglossal nerve stimulation (HGNS).
• Drug-induced sleep endoscopy (DISE) maneuvers, like jaw thrust and chin lift, have been explored as predictors for treatment success in OSA.
• HGNS efficacy is linked to palatoglossus muscle activation, influencing velum opening during sleep.

Purpose of the Study:

• To evaluate the predictive value of maneuvers during DISE for HGNS treatment efficacy in OSA patients.
• To determine if jaw thrust and chin lift maneuvers during DISE correlate with improved apnea-hypopnea index (AHI) after HGNS.

Main Methods:

• Retrospective analysis of 171 patients undergoing HGNS from November 2014 to February 2021.
• Assessment of jaw thrust and chin lift maneuvers during preoperative DISE, rating tongue base and palatal opening.
• Categorization of responses as weak (score 1-2) or strong (score 3-4) and calculation of AHI change from preoperative to postoperative sleep studies.

Main Results:

• No significant difference in AHI change was observed between weak and strong responders for either jaw thrust or chin lift maneuvers at the palate or tongue base.
• Multiple linear regression indicated that lower BMI, higher preoperative AHI, and higher preoperative oxygen nadir were associated with greater AHI reduction.
• Palatal and tongue base opening during maneuvers did not reliably predict HGNS treatment outcomes.

Conclusions:

• Palatal coupling maneuvers performed during DISE are not effective predictors of AHI reduction with HGNS treatment.
• The study suggests that findings from these specific DISE maneuvers should not disqualify patients from being considered for HGNS therapy.
• Further research may be needed to identify more reliable predictors of HGNS success in OSA patients.