Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi-institutional Review

Abstract

Objectives/hypothesis: An elevated body mass index (BMI) influences the severity of disease and treatment options utilized for obstructive sleep apnea (OSA). With this study, we aim to evaluate a cohort of patients undergoing upper airway stimulation (UAS) for treatment of OSA and assess the impact of BMI on surgical and quality of life outcomes.

Methods: We designed a case-control, retrospective review, of all patients undergoing UAS at two academic institutions between 2014 and 2017. We compare those with an elevated BMI to those without. We included patients with moderate-severe OSA, who were unable to tolerate therapy with continuous positive airway pressure (CPAP), were treated with UAS, and had a postoperative sleep study performed. We evaluated postoperative sleep study data including apnea-hypopnea index (AHI), O₂ desaturation nadir, rate of cure, and rate of success in those with an elevated BMI to those without an elevated BMI. Success was defined as a drop in the postoperative AHI by 50% compared to the preoperative value and to less than 20. We also assessed daytime sleepiness using the Epworth Sleepiness Scale.

Results: When defining an elevated BMI as greater than 32, we found no difference between elevated and nonelevated BMI cohorts in postoperative AHI, O₂ desaturation nadir, daytime sleepiness, rate of surgical success, or rate of cure.

Conclusions: Patients with obstructive sleep apnea, unable to tolerate CPAP, and with an elevated BMI can be successfully treated with upper airway stimulation therapy.

Level of evidence: 3. Laryngoscope, 128:2425-2428, 2018.

Keywords: Obstructive sleep apnea; sleep apnea; upper airway stimulation.