Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?

Area of Science:

• Medical Devices
• Sleep Medicine
• Neurosurgery

Background:

• Upper airway stimulation (UAS) is an effective treatment for moderate-to-severe obstructive sleep apnea (OSA).
• The therapy involves electrical stimulation of the hypoglossal nerve via an implanted electrode cuff.
• Optimizing electrode placement is crucial for treatment efficacy and patient adherence.

Purpose of the Study:

• To evaluate the impact of electrode cuff positioning on Upper airway stimulation (UAS) outcomes.
• Specifically, to determine if cuff position influences device adherence in OSA patients.

Main Methods:

• Retrospective analysis of 327 patients receiving UAS for OSA between 2016-2021.
• Electrode position (spine up vs. spine down) determined by postoperative X-ray.
• Adherence data analyzed from downloaded UAS device usage logs.

Main Results:

• A 'spine down' cuff position was associated with significantly higher UAS adherence (45.4 vs. 41.0 hours/week).
• No significant association found between cuff position and therapeutic amplitude, AHI reduction, or symptom improvement (ESS).
• Multivariable analysis confirmed 'spine down' position and older age correlate with increased adherence.

Conclusions:

• Upper airway stimulation (UAS) cuff placement with the spine down is linked to improved device adherence.
• Further research into the optimal positioning of UAS electrode cuffs is recommended.
• This finding may guide surgical techniques to enhance patient compliance with UAS therapy.