Anthropometric Measurements Inform Complete Concentric Collapse Status in Patients With Obstructive Sleep Apnea

Hypoglossal nerve stimulation in the US requires drug-induced sleep endoscopy to exclude patients with complete concentric collapse. This is an expensive and time-consuming requirement. We hypothesized that supine pharyngeal width, and other demographic and polysomnographic variables would associate with complete concentric collapse.

Prospective, multicenter cohort study.

10 centers in the United States with experience selecting patients for and performing airway surgeries for sleep apnea including hypoglossal nerve stimulation implantation.

600 patients meeting criteria for hypoglossal nerve stimulation underwent measurement of supine pharyngeal width and collection of demographic and polysomnographic data followed by drug-induced sleep endoscopy.

587 patients completed the study. Patients with complete concentric collapse had a higher body mass index (31.2 ± 3.2 vs 29.0 ± 3.4 kg/m², P < .001), larger neck circumference (45.5 ± 4.2 vs 40.6 ± 4.7 cm, P < .001), and lower supine pharyngeal width (19.4 ± 6.3 vs 21.8 ± 6.5 mm; P = .008) than patients without complete concentric collapse.

Body mass index, neck circumference, and supine pharyngeal width all associate with complete concentric collapse and could potentially be used to determine hypoglossal nerve stimulation candidacy instead of drug-induced sleep endoscopy for most patients thereby reducing both time and cost. (ClinicalTrials.gov NCT05428839: https://clinicaltrials.gov/study/NCT05428839?term=Inspire%20Medical%20systems%20predictor&rank=1).