Huyett Phillip
Division of Sleep Medicine and Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2022 Mar;166(3):589-594. doi: 10.1177/01945998211023479. Epub 2021 Jun 29.
To examine the changes in measures of sleep apnea severity and hypoxemia on the first postoperative night following implantation of the hypoglossal nerve stimulator.
This was a single-arm prospective cohort study.
A single academic sleep surgical practice.
Subjects with moderate to severe obstructive sleep apnea underwent implantation of the hypoglossal nerve stimulator (HGNS) and were discharged to home the same day as surgery. A single-night WatchPAT study was performed on the night immediately following surgery (PON 1) and was compared to baseline sleep testing.
Twenty subjects who were an average of 58.6 ± 2.5 years old, were 25% female, and had a mean body mass index of 28.1 ± 0.9 kg/m completed the study. Mean O nadir at baseline was 79.6% ± 1.1% compared to 82.7% ± 0.9% ( = .013) on PON 1. One patient demonstrated a >10% worsening in O nadir. Only 2 additional patients demonstrated a worsening in O nadir on PON 1, each by only 1 percentage point. Neither mean time spent below SpO 88% nor oxygen desaturation index (ODI) worsened postoperatively (mean time spent below oxygen saturation of 88%, 27.8 ± 7.85 vs 11.2 ± 5.2, = .03; mean ODI, 29.6 ± 5.2/h vs 21.0 ± 5.4/h, = .10). Mean obstructive apnea hypopnea index (AHI) was no worse (40.6 ± 4.7/h to 28.7 ± 4.2/h, = .02), with only 2 patients experiencing an obstructive AHI >20% more severe than baseline. Only 1 patient demonstrated a clinically meaningful increase in central AHI on PON 1.
Overall, AHI and measures of nocturnal hypoxemia are stable, if not improved, on PON 1 following HGNS implantation. These findings support the safety of same-day discharge following implantation of the hypoglossal nerve stimulator.
研究舌下神经刺激器植入术后第一个夜晚睡眠呼吸暂停严重程度及低氧血症指标的变化。
这是一项单臂前瞻性队列研究。
一家学术性睡眠外科诊所。
患有中度至重度阻塞性睡眠呼吸暂停的受试者接受舌下神经刺激器（HGNS）植入，并于手术当天出院回家。在术后紧接着的那个夜晚（术后第1晚）进行单次夜间WatchPAT研究，并与基线睡眠测试进行比较。
20名平均年龄为58.6±2.5岁、女性占25%、平均体重指数为28.1±0.9kg/m²的受试者完成了研究。基线时平均最低血氧饱和度为79.6%±1.1%，而术后第1晚为82.7%±0.9%（P = 0.013）。1名患者的最低血氧饱和度恶化超过10%。术后第1晚仅另外2名患者的最低血氧饱和度有所恶化，每人仅恶化1个百分点。术后低于SpO₂ 88%的平均时长和氧减饱和度指数（ODI）均未恶化（低于88%氧饱和度的平均时长，27.8±7.85对11.2±5.2，P = 0.03；平均ODI，29.6±5.2次/小时对21.0±5.4次/小时，P = 0.10）。平均阻塞性睡眠呼吸暂停低通气指数（AHI）也未变差（40.6±4.7次/小时至28.7±4.2次/小时，P = 0.02），只有2名患者的阻塞性AHI比基线严重超过20%。术后第1晚只有1名患者的中枢性AHI出现了具有临床意义的增加。
总体而言，在植入HGNS后的术后第1晚，AHI和夜间低氧血症指标即使没有改善也是稳定的。这些发现支持了舌下神经刺激器植入术后当日出院的安全性。
