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Right Versus Left Cuff Position for Upper Airway Stimulation.

Alexandra M Arambula1,2, Antonio Bon-Nieves1, Rahul Alapati1

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.

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Summary
This summary is machine-generated.

This study found no significant differences in obstructive sleep apnea treatment outcomes between left-down (L-down) and right-up (R-up) upper airway stimulation (UAS) implants. While L-down implants showed higher adherence in initial analysis, this was not sustained in further review.

Keywords:
adherenceobstructive sleep apneaupper airway stimulation

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Area of Science:

  • Sleep Medicine
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated upper airway collapse during sleep.
  • Upper airway stimulation (UAS) offers an alternative treatment for OSA by electrically stimulating the hypoglossal nerve to maintain airway patency.
  • Implant positioning, specifically the electrode cuff orientation (L-down vs. R-up), may influence UAS efficacy and patient outcomes.

Purpose of the Study:

  • To evaluate the impact of left-sided (L-down) versus right-sided (R-up) upper airway stimulation (UAS) electrode cuff orientation on patient outcomes for obstructive sleep apnea.
  • To compare treatment success, adherence, and polysomnographic parameters between L-down and R-up UAS cohorts.

Main Methods:

  • Retrospective cohort study including 190 patients who underwent UAS implantation between 2016 and 2021.
  • Patients were categorized based on X-ray confirmed electrode cuff orientation: L-down (inferiorly oriented) or R-up (superiorly oriented).
  • Analysis utilized most recent sleep study variables, comparing apnea-hypopnea index, treatment success, adherence, and Epworth Sleepiness Scale scores.

Main Results:

  • No significant differences were observed in the decrease of apnea-hypopnea index, treatment success rates, functional threshold, therapeutic amplitude, or Epworth Sleepiness Scale scores between the L-down and R-up groups.
  • Device adherence (hours of use per week) was significantly higher in the L-down group in univariate analysis (47.1 vs. 41.0 hours/week), but this difference was not maintained in multivariate analysis.
  • Reasons for L-down orientation included hunting/shooting, prior radiation/surgery, central port, and brachial plexus injury.

Conclusions:

  • The orientation of the UAS electrode cuff (L-down vs. R-up) did not result in significantly different treatment outcomes for obstructive sleep apnea patients.
  • While univariate analysis suggested higher adherence with L-down implants, this finding requires further investigation in larger cohorts.
  • Future research with larger patient populations is warranted to explore the relationship between electrode cuff orientation and UAS treatment outcomes.