Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA.
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH, USA.
Sleep Breath. 2024 Nov 25;29(1):6. doi: 10.1007/s11325-024-03174-2.
Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2-6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (β = 3.7, CI [1.3, 7.4], p = 0.038) and increased age (β = 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.
上气道刺激（UAS）是治疗中重度阻塞性睡眠呼吸暂停（OSA）的一种选择，通过电极袖带对舌下神经施加电刺激。在这项研究中，我们评估了电极袖带位置对 UAS 结果的影响，特别是对设备依从性的影响。
在 2016 年至 2021 年间，符合 UAS 美国食品和药物管理局标准的单所学术机构的患者被纳入研究。根据术后侧颈 X 光片，将电极位置记录为舌下神经上方（袖带脊柱向上）或下方（袖带脊柱向下）。患者在手术后 2-6 个月接受滴定多导睡眠图检查。在滴定多导睡眠图后，使用睡眠研究中最近的术后变量进行统计分析。从 UAS 设备下载依从性数据。
327 名患者符合纳入标准。患者的平均年龄为 60.9±11.1 岁，女性 105 例（32.1%）。与 158 例（48.3%）袖带脊柱向下的患者相比，169 例（51.7%）患者的袖带脊柱向上。袖带脊柱向下的患者 UAS 依从性明显更高（45.4 比 41.0 小时设备使用/周，p=0.015）。袖带位置与治疗幅度、呼吸暂停低通气指数变化或 Epworth 嗜睡量表测量的症状变化无显著相关性。在多变量线性回归分析中，袖带脊柱向下位置（β=3.7，CI [1.3，7.4]，p=0.038）和年龄增加（β=0.22，CI [0.07，0.38]，p=0.005）与依从性增加相关。
UAS 袖带脊柱向下位置与设备依从性增加有关。需要进一步研究袖带位置。
