[Efficient sleep endoscopy planning prior to breathing-dependent unilateral hypoglossal nerve stimulation]

The implantation of breathing-dependent unilateral hypoglossal nerve stimulation (HNS) has traditionally required the preoperative exclusion of complete concentric velopharyngeal collapse (CCC) through drug-induced sleep endoscopy (DISE). This prerequisite poses logistical and operational challenges for implantation teams. To address these issues the Eppendorf DISE concept was developed to streamline the process, making it more patient-friendly, cost-effective, and time-efficient.

We retrospectively examined HNS patients who were preoperatively examined for CCC using the Müller maneuver and simulated snoring in a supine position using transnasal flexible endoscopy. If the findings were unremarkable, with no evidence of CCC, the DISE was performed directly before the implantation in the same procedure.

We examined 28 patients of whom 7.9% presented remarkable findings during the Müller maneuver or simulated snoring. These patients also showed a CCC during DISE. If the Müller maneuver was unremarkable no CCC was observed in DISE either, resulting in 100% sensitivity, specificity, positive and negative predictive values. Thus, there is a significant direct relationship between Müller maneuver results and velopharyngeal findings during DISE as confirmed by Fisher's exact test (p = 0.0026, p < 0.05).

The Eppendorf DISE concept has shown to be a reliable method for predicting a low likelihood of CCC in a patient-oriented, cost-effective and time-efficient manner. It is yet to be determined how long the CCC will remain as an exclusion criterion for breathing-dependent unilateral HNS implantation.