超声评估舌运动指导下的舌下神经刺激治疗阻塞性睡眠呼吸暂停的优化。

Optimization of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea With Ultrasound Assessment of Tongue Movement.

机构信息

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Great Neck, NY; and.

Department of Otolaryngology, Head and Neck Center of Surgery, Zucker Sinus Center-Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Great Neck, NY.

出版信息

Am J Ther. 2021 Jul 14;29(2):e205-e211. doi: 10.1097/MJT.0000000000001424.

DOI:10.1097/MJT.0000000000001424

PMID:34264881

Abstract

BACKGROUND

Hypoglossal nerve stimulation (HGNS) is an Food and Drug Administration-approved therapy for obstructive sleep apnea. Initial programming of HGNS is based on the observation of anterior tongue movement, which may not reflect opening at the retroglossal airway. We developed an ultrasonographic technique to assess the base of tongue movement with HGNS to be used to optimize the initial voltage settings.

STUDY QUESTION

This study aimed to investigate the use of ultrasound to assess tongue movement with HGNS and related this measure to the apnea hypopnea index (AHI) on subsequent home sleep apnea testing or in-laboratory polysomnography with therapy.

STUDY DESIGN

Seventeen subjects (n = 17) implanted with HGNS were enrolled at least 1 month postimplantation. Ultrasonographic measures were then used to optimize HGNS voltage to produce observable base of tongue protrusion without producing discomfort. Responders were defined as a reduction in AHI > 50% and an AHI of <20 events/h.

RESULTS

There were 17 subjects, 11 men and 6 women, with age = 64.6 ± 9.8 years, body mass index = 27.9 ± 2.7 kg/m2, and pretreatment AHI = 36.5 ± 14.4/h, T-90% = 10.7 ± 14.8%. The mean hyoid bone excursion (HBE) in responders = 1.0 ± 0.13 cm versus 0.82 ± 0.12 cm in nonresponders (P = 0.017). HBE was correlated with AHI during HGNS treatment (coef. -0.54, P = 0.03). Best subsets regression analysis using treatment-based AHI as the dependent variable and age, body mass index, baseline AHI, HBE, and HGNS voltage as independent variables showed that HBE (coef. -44.6, P = 0.044) was the only independent predictor of response. Receiver operator curve analysis showed that HBE > 0.85 cm had a sensitivity of 83.3% and specificity of 80.0% with a positive likelihood ratio of 4.17 to predict responder status.

CONCLUSION

We demonstrated that ultrasound assessment of HBE during HGNS programming is a useful tool to optimize therapy.

摘要

背景

舌下神经刺激（HGNS）是一种经食品和药物管理局批准的治疗阻塞性睡眠呼吸暂停的方法。HGNS 的初始编程基于观察前舌运动，而这可能无法反映会厌后气道的开放。我们开发了一种超声技术来评估 HGNS 治疗时舌根部的运动，并将其用于优化初始电压设置。

研究问题

本研究旨在探讨使用超声评估 HGNS 治疗时的舌运动，并将该测量指标与随后的家庭睡眠呼吸暂停测试或实验室多导睡眠图中的治疗相关的呼吸暂停低通气指数（AHI）相关联。

研究设计

17 名（n=17）植入 HGNS 的受试者在植入后至少 1 个月入组。然后使用超声测量来优化 HGNS 电压，以产生可观察到的舌根部突出，而不会产生不适。有反应者定义为 AHI 降低>50%且 AHI<20 次/小时。

结果

共有 17 名受试者，11 名男性和 6 名女性，年龄为 64.6±9.8 岁，体重指数为 27.9±2.7kg/m2，治疗前 AHI 为 36.5±14.4 次/小时，T-90%为 10.7±14.8%。有反应者的舌骨上移幅度（HBE）平均值为 1.0±0.13cm，而无反应者为 0.82±0.12cm（P=0.017）。在 HGNS 治疗期间，HBE 与 AHI 呈负相关（系数-0.54，P=0.03）。使用基于治疗的 AHI 作为因变量，年龄、体重指数、基线 AHI、HBE 和 HGNS 电压作为自变量的最佳子集回归分析表明，HBE（系数-44.6，P=0.044）是反应的唯一独立预测因子。受试者工作特征曲线分析显示，HBE>0.85cm 预测反应状态的敏感性为 83.3%，特异性为 80.0%，阳性似然比为 4.17。