Yalamanchi Pratyusha, Mott Nicole, Ali Syed Ahmed, Peddireddy Nithin S, Kovatch Kevin J, Stanley Jeffrey J, Hoff Paul T
Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Otolaryngol Head Neck Surg. 2022 Mar;166(3):595-597. doi: 10.1177/01945998211023733. Epub 2021 Jun 29.
Candidacy evaluation for hypoglossal nerve stimulation (HGNS) is resource intensive. This proof-of-concept study investigates use of in-office volitional snore during flexible laryngoscopy as an efficient, cost-effective screening tool for HGNS evaluation. Adults with moderate to severe obstructive sleep apnea that failed continuous positive airway pressure treatment (n = 41) underwent evaluation for HGNS from 2018 to 2019. Volitional snore and drug-induced sleep endoscopy (DISE) data were collected and scored by VOTE classification (velum/palate, oropharynx, tongue base, epiglottis). A chi-square test of independence was performed that demonstrated a significant relationship between volitional snore and DISE (χ = 4.39, = .036) for velum collapse pattern. Sensitivity and specificity of volitional snore for detecting velum collapse pattern were 93.6% (95% CI, 75.6%-99.2%) and 40% (95% CI, 12.2%-73.8%), respectively, illustrating its utility in screening for HGNS. Patients who demonstrate anterior-posterior velum collapse on volitional snore may be excellent candidates for confirmatory DISE at the time of HGNS implantation.
舌下神经刺激术（HGNS）的候选资格评估资源消耗大。这项概念验证研究调查了在软性喉镜检查期间使用自主打鼾作为HGNS评估的一种高效、经济有效的筛查工具。2018年至2019年，对41例持续气道正压通气治疗失败的中重度阻塞性睡眠呼吸暂停成人患者进行了HGNS评估。收集自主打鼾和药物诱导睡眠内镜检查（DISE）数据，并根据VOTE分类（软腭/腭、口咽、舌根、会厌）进行评分。进行了独立性卡方检验，结果表明自主打鼾与DISE在软腭塌陷模式方面存在显著相关性（χ = 4.39，P = .036）。自主打鼾检测软腭塌陷模式的敏感性和特异性分别为93.6%（95%CI，75.6%-99.2%）和40%（95%CI，12.2%-73.8%），说明了其在HGNS筛查中的效用。在自主打鼾时表现出软腭前后塌陷的患者可能是HGNS植入时进行确诊性DISE的极佳候选者。
