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. 2019 Aug 15;15(8):1165-1172.
doi: 10.5664/jcsm.7814.

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Clara H Lee  1 , Everett G Seay  2 , Benjamin K Walters  3 , Nicholas J Scalzitti  4 , Raj C Dedhia  2
Affiliations

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Clara H Lee et al. J Clin Sleep Med. .

Abstract

Study objectives: To determine whether therapeutic positive airway pressure (PAP) level predicts response to hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea using the coprimary outcomes of apnea-hypopnea index (AHI) and 4% oxygen desaturation index.

Methods: Combined cohort study from two US sleep otolaryngology training programs. Subjects were adults with AHI > 15 events/h who underwent HGNS. Eligible subjects had diagnostic preoperative sleep studies, full-night efficacy postoperative studies and therapeutic PAP levels available for analysis. Low and high PAP groups were compared using the t test for continuous variables and chi-square test for categorical variables.

Results: Fifty-six patients met all inclusion criteria. On average, patients were male, Caucasian, middle-aged, and overweight. Thirteen patients were in the low PAP group (< 8 cm H₂O) and 43 patients in the high PAP group (≥ 8 cm H₂O). Although both groups experienced improvement of polysomnographic measures with HGNS, the low PAP group achieved a significantly larger mean AHI reduction (36.7 ± 22.7 versus 18.4 ± 23.4, P = .02). Additionally, the low PAP group had a greater response rate (defined as AHI < 20 events/h and > 50% reduction of AHI) than the high PAP group (92% versus 44%, P < .01).

Conclusions: Therapeutic PAP level may aid in the discernment of candidacy for HGNS, with a strong positive predictive value for PAP levels < 8 cm H₂O. A larger prospective study is needed to confirm these findings.

Citation: Lee CH, Seay EG, Walters BK, Scalzitti NJ, Dedhia RC. Therapeutic positive airway pressure level predicts response to hypoglossal nerve stimulation for obstructive sleep apnea. J Clin Sleep Med. 2019;15(8):1165-1172.

Keywords: hypoglossal nerve stimulation; obstructive sleep apnea; positive airway pressure; sleep surgery.

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Figures

Figure 1
Figure 1. Predictors of HGNS response.
Blue line shows the receiver operating characteristic curve for (A) therapeutic PAP level, (B) body mass index, and (C) AHI as predictors of HGNS response. Response defined as AHI reduction > 50% and AHI < 20 events/h. Red line shows the null hypothesis. AHI = apnea-hypopnea index, HGNS = hypoglossal nerve stimulation, PAP = positive airway pressure.
See this image and copyright information in PMC

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