Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Laryngoscope. 2023 Feb;133(2):431-436. doi: 10.1002/lary.30397. Epub 2022 Sep 21.
OBJECTIVE(S): Maneuvers during drug-induced sleep endoscopy (DISE), for patients with obstructive sleep apnea (OSA), have been used as predictors for success with oral appliances. Hypoglossal nerve stimulation (HGNS) promotes opening at the velum through palatoglossus coupling. In this study, we evaluate maneuvers during DISE as predictors for HGNS treatment efficacy.
We evaluated patients undergoing HGNS between November, 2014 and February, 2021. We assessed maneuvers including jaw thrust and chin lift during preoperative DISE. The impact of tongue base and palatal opening during these maneuvers were rated from 1 to 4 (1: no improvement, 2: mild improvement, 3: moderate improvement, 4: significant improvement). Patients were grouped by a score of 1-2 (weak response) or 3-4 (strong response). Apnea hypopnea index (AHI) change was calculated from the difference between preoperative and postoperative sleep study.
One hundred and seventy one patients were included. With jaw thrust, there was no significant difference in AHI change between patients with weak or strong response at the palate (n = 68 vs. 94, 9.5 vs. 13.6, p = 0.21) or tongue base (n = 24 vs. 138, 16.6 vs. 11.3, p = 0.24). On chin lift, there was no significant difference at the palate (n = 82 vs. 18, 13.9 vs. 11.4, p = 0.63) or tongue base (n = 92 vs. 72, 10.8 vs. 14.6, p = 0.24). On multiple linear regression analysis, lower body mass index, higher preoperative AHI, and higher preoperative oxygen nadir were associated with a larger AHI change.
Palatal coupling maneuvers during DISE are not predictive of AHI change with HGNS. Findings using these maneuvers should not preclude HGNS candidacy.
3 Laryngoscope, 133:431-436, 2023.
对于阻塞性睡眠呼吸暂停（OSA）患者，药物诱导睡眠内镜检查（DISE）期间的操作已被用作口腔矫治器治疗成功的预测指标。舌下神经刺激（HGNS）通过腭舌肌耦合促进软腭张开。在这项研究中，我们评估 DISE 期间的操作是否可作为 HGNS 治疗效果的预测指标。
我们评估了 2014 年 11 月至 2021 年 2 月期间接受 HGNS 的患者。我们评估了包括术前 DISE 中的下颌前伸和下巴抬起在内的操作。在这些操作中，舌基底和腭部的张开程度从 1 到 4 分（1：无改善，2：轻度改善，3：中度改善，4：明显改善）进行评分。根据评分 1-2（弱反应）或 3-4（强反应）对患者进行分组。AHI 变化通过术前和术后睡眠研究之间的差异计算得出。
共纳入 171 例患者。对于下颌前伸，腭部弱反应和强反应患者的 AHI 变化无显著差异（n=68 与 94，9.5 与 13.6，p=0.21）或舌基底（n=24 与 138，16.6 与 11.3，p=0.24）。对于下巴抬起，腭部弱反应和强反应患者的 AHI 变化无显著差异（n=82 与 18，13.9 与 11.4，p=0.63）或舌基底（n=92 与 72，10.8 与 14.6，p=0.24）。多元线性回归分析显示，较低的体重指数、较高的术前 AHI 和较低的术前氧减饱和度与 AHI 变化较大相关。
DISE 期间的腭部耦合操作并不能预测 HGNS 治疗的 AHI 变化。使用这些操作的结果不应排除 HGNS 的候选资格。
3《喉镜》，133：431-436，2023 年。
