Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA.
Otolaryngol Head Neck Surg. 2024 Apr;170(4):1183-1189. doi: 10.1002/ohn.668. Epub 2024 Feb 3.
Upper airway stimulation (UAS) is a treatment option for obstructive sleep apnea in which electrical stimulation is applied to the hypoglossal nerve. Nerve branches that control tongue protrusion are located inferiorly. Due to positioning, left-sided implants are typically placed with an inferiorly oriented electrode cuff (L-down) as opposed to superiorly on the right (R-up). In this study, we assess the impact of left- versus right-sided UAS on patient outcomes.
Retrospective cohort study.
Tertiary Academic Medical Center.
Patients who underwent UAS implantation between 2016 and 2021 with an L-down or R-up oriented cuff as confirmed by X-ray were included. Data were collected retrospectively. Most recent sleep study variables were used for analysis.
A total of 190 patients met the inclusion criteria. The average age was 61.0 ± 11.0 years, with 55 (28.9%) females. L-down orientation was present in 21 (11.1%) patients vs 169 (88.9%) R-up. Indications for L-down included hunting/shooting (n = 15), prior radiation/surgery (n = 4), central port (n = 1), and brachial plexus injury (n = 1). Adherence was higher among L-down patients (47.1 vs 41.0 hours use/week, P = .037) in univariate analysis, with a similar time to adherence data collection (4.4 vs 4.2 months, P = .612), though this finding was not maintained in the multivariate regression analysis. Decrease in apnea-hypopnea index (21.3 vs 22.8, P = .734), treatment success (76.5% vs 84.0%, P = .665), functional threshold (1.5 vs 1.6, P = .550), therapeutic amplitude (2.3 vs 2.4, P = .882), and decrease in Epworth Sleepiness Scale (4.9 vs 2.6, P = .060) were not significantly different between cohorts.
This study is the first to examine the orientation of the UAS electrode cuff concerning the electrodes' natural position and the potential effect on postoperative outcomes. Our study found no significantly different treatment outcomes between the L-down versus R-up cohort, with the exception of device adherence, which was significantly higher in the L-down group on univariate analysis though not on multivariate analysis. Future studies with larger patient cohorts are needed to further investigate this potential relationship between treatment outcomes and electrode cuff orientation.
上呼吸道刺激（UAS）是治疗阻塞性睡眠呼吸暂停的一种方法，其中对舌下神经施加电刺激。控制舌突出的神经分支位于下方。由于定位原因，左侧植入物通常采用向下取向的电极袖带（L-down），而不是右侧（R-up）。在这项研究中，我们评估了左侧与右侧 UAS 对患者结局的影响。
回顾性队列研究。
三级学术医疗中心。
纳入了 2016 年至 2021 年间接受 UAS 植入术且 X 射线证实采用 L-down 或 R-up 取向袖带的患者。数据通过回顾性收集。分析使用最近的睡眠研究变量。
共有 190 名符合纳入标准的患者。平均年龄为 61.0±11.0 岁，其中 55 名（28.9%）为女性。L-down 定位组有 21 名（11.1%）患者，而 R-up 定位组有 169 名（88.9%）。L-down 定位的适应证包括狩猎/射击（n=15）、既往放疗/手术（n=4）、中央端口（n=1）和臂丛损伤（n=1）。在单变量分析中，L-down 患者的依从性更高（47.1 小时/周 vs 41.0 小时/周，P=0.037），但在多变量回归分析中，这种差异并不明显。L-down 组和 R-up 组的呼吸暂停低通气指数（21.3 比 22.8，P=0.734）、治疗成功率（76.5%比 84.0%，P=0.665）、功能阈值（1.5 比 1.6，P=0.550）、治疗幅度（2.3 比 2.4，P=0.882）和 Epworth 睡眠量表评分（4.9 比 2.6，P=0.060）的降低均无显著差异。
这项研究首次检查了 UAS 电极袖带的取向与电极自然位置之间的关系，以及这对术后结果的潜在影响。我们的研究发现，L-down 组与 R-up 组之间的治疗结果无显著差异，除了设备依从性，L-down 组在单变量分析中显著更高，但在多变量分析中不显著。需要更大患者队列的进一步研究来进一步探讨治疗结果和电极袖带取向之间的潜在关系。
