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Treatment Outcomes in Awake Endoscopy With Advanced Programming in Hypoglossal Nerve Stimulation.

Troy Wesson1, Mohamad Z Saltagi1,2, Shalini Manchanda1,2,3

  • 1Indiana University School of Medicine, Indianapolis, IN, USA.

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Hypoglossal nerve stimulation (HNS) with advanced programming (AEAP) improved sleep apnea outcomes for many patients. Anatomical factors, like tongue base collapse, significantly influenced treatment success, highlighting the need for personalized therapy.

Keywords:
Inspireadvanced programmingawake endoscopyhypoglossal nerve stimulationobstructive sleep apneaupper airway stimulation

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Area of Science:

  • Sleep Medicine
  • Otolaryngology
  • Biomedical Engineering

Background:

  • Obstructive sleep apnea (OSA) is a common condition impacting patient health and quality of life.
  • Hypoglossal nerve stimulation (HNS) offers an alternative treatment for moderate-to-severe OSA, particularly for patients intolerant to positive airway pressure (PAP) therapy.
  • Awake endoscopy with advanced programming (AEAP) is a post-implantation technique to optimize HNS therapy.

Purpose of the Study:

  • To analyze response patterns to HNS following AEAP in OSA patients.
  • To identify patient-specific characteristics associated with successful HNS therapy after AEAP.
  • To evaluate the impact of AEAP on both apnea-hypopnea index (AHI) reduction and patient comfort.

Main Methods:

  • Retrospective analysis of 17 consecutive patients undergoing AEAP for HNS between June 2019 and December 2022.
  • Patients were grouped based on post-AEAP non-titration AHI (NT-AHI) reduction.
  • Statistical analyses included Chi-squared tests, Pearson correlation, and independent samples t-tests (P < .05 significance).

Main Results:

  • A majority of patients (88.2%) underwent AEAP due to insufficient NT-AHI reduction, while 11.8% sought comfort improvements.
  • 65% of patients experienced improved post-AEAP NT-AHI, whereas 35% did not show improvement.
  • Patients with lateral or concentric tongue base collapse were significantly less likely to achieve NT-AHI improvement (P = .017).

Conclusions:

  • AEAP is effective in refining HNS settings for improved efficacy and tolerability in OSA patients.
  • Airway anatomical phenotypes, particularly tongue base characteristics, are critical predictors of HNS treatment success.
  • Personalized therapy titration considering upper airway anatomy is essential for optimizing HNS outcomes.