Perelman School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia.
Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.
JAMA Otolaryngol Head Neck Surg. 2020 Aug 1;146(8):691-698. doi: 10.1001/jamaoto.2020.1018.
Recent retrospective hypoglossal nerve stimulation (HGNS) outcomes data suggest that patients with low therapeutic positive airway pressure (PAP) levels achieve greater success than patients with high therapeutic PAP levels.
To examine the use of therapeutic nasal PAP levels at the soft palate in predicting the outcomes of HGNS for patients with obstructive sleep apnea.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used drug-induced sleep endoscopy (DISE) to evaluate the predictive capacity of therapeutic PAP levels in HGNS outcomes. In an academic sleep surgery center, 27 consecutive patients with obstructive sleep apnea who underwent DISE before implantation of an HGNS device were evaluated. The study was conducted from May 1, 2018, to June 26, 2019.
Positive airway pressure delivered through a nasal mask during DISE.
Improvement in apnea-hypopnea index as measured from full-night preoperative and postoperative efficacy studies.
Twenty-seven patients met all inclusion criteria. The mean (SD) age was 62.0 (14.4) years, 14 participants were men (51.9%), and mean body mass index was 28.1 (4.0). Responders to HGNS therapy (n = 18) had significantly lower mean (SD) palatal opening pressure compared with nonresponders (n = 9) (5.0 [2.8] vs 9.2 [3.7] cm H2O, respectively; mean difference, -4.2; 95% CI, -6.8 to -1.6 cm H2O). After adjusting for age, sex, and body mass index, the mean palatal opening pressure value for the responders remained 3.5 cm H2O lower (95% CI, -6.7 to -0.4 cm H2O) than that of nonresponders. A palatal opening pressure cutoff level less than 8 cm H2O demonstrated a positive predictive value of 82.4%; sensitivity, 77.8%; and specificity, 66.7%.
In this small prospective cohort study, therapeutic nasal PAP levels during DISE differed significantly between responder and nonresponders to HGNS. Because DISE represents a mandatory, relatively standardized diagnostic tool for HGNS candidacy, the use of therapeutic nasal PAP through DISE can be broadly implemented and studied across multiple centers to possibly improve patient selection for HGNS.
最近回顾性舌下神经刺激（HGNS）结果数据表明，治疗性正压通气（PAP）水平较低的患者比治疗性 PAP 水平较高的患者成功率更高。
研究治疗性鼻 PAP 水平在软腭处对预测阻塞性睡眠呼吸暂停患者 HGNS 结果的作用。
设计、地点和参与者：这项前瞻性队列研究使用药物诱导睡眠内窥镜（DISE）评估 HGNS 结果中治疗性 PAP 水平的预测能力。在一家学术睡眠外科中心，对 27 例连续接受 DISE 检查后植入 HGNS 装置的阻塞性睡眠呼吸暂停患者进行评估。研究于 2018 年 5 月 1 日至 2019 年 6 月 26 日进行。
鼻罩在 DISE 期间提供的气道正压。
从术前和术后全夜功效研究中测量的呼吸暂停低通气指数改善情况。
27 例患者均符合所有纳入标准。患者平均（标准差）年龄为 62.0（14.4）岁，14 例为男性（51.9%），平均体重指数为 28.1（4.0）。HGNS 治疗的应答者（n=18）的腭部张开压明显低于无应答者（n=9）（分别为 5.0[2.8]和 9.2[3.7]cmH2O；平均差值，-4.2；95%CI，-6.8 至-1.6cmH2O）。在调整年龄、性别和体重指数后，应答者的腭部张开压平均仍低 3.5cmH2O（95%CI，-6.7 至-0.4cmH2O）于无应答者。腭部张开压临界值小于 8cmH2O 时，阳性预测值为 82.4%；灵敏度为 77.8%；特异性为 66.7%。
在这项小型前瞻性队列研究中，HGNS 应答者和无应答者的 DISE 期间的治疗性鼻 PAP 水平有显著差异。由于 DISE 是 HGNS 候选者的强制性、相对标准化的诊断工具，因此可以在多个中心广泛使用 DISE 中的治疗性鼻 PAP 进行研究，以可能改善 HGNS 的患者选择。
