Troubleshooting Upper Airway Stimulation Therapy Using Drug-Induced Sleep Endoscopy

Area of Science:

• Sleep Medicine
• Otolaryngology
• Medical Devices

Background:

• Obstructive sleep apnea (OSA) poses significant health risks.
• Upper airway stimulation (UAS) is an alternative therapy for OSA.
• Some patients experience challenges with UAS therapy, including intolerance or inadequate response.

Purpose of the Study:

• To evaluate the effectiveness of drug-induced sleep endoscopy (DISE) in managing patients with OSA undergoing UAS therapy.
• To determine how DISE findings can guide subsequent treatment decisions for patients with suboptimal UAS outcomes.

Main Methods:

• Retrospective analysis of 34 patients with OSA who underwent DISE after initiating UAS therapy.
• Assessment of palatal coupling (PC) during DISE using UAS stimulation, jaw thrust, and combined maneuvers.
• Evaluation of treatment recommendations based on DISE findings, including oral appliance therapy (OAT) and surgical interventions.

Main Results:

• Among 34 patients, 24% to 26% showed palatal coupling with specific maneuvers during DISE-UAS.
• 10 patients (29%) did not exhibit palatal coupling with any tested maneuver.
• DISE-UAS findings led to recommendations for OAT in 13 patients and further surgery in 8 patients.

Conclusions:

• Drug-induced sleep endoscopy (DISE) is a valuable tool for troubleshooting UAS therapy in OSA patients.
• DISE-UAS aids in identifying specific causes of treatment failure, enabling personalized, multimodality treatment strategies.
• This approach facilitates tailored management for patients with OSA who are intolerant to CPAP or have suboptimal UAS efficacy.