Vena Daniel, Op de Beeck Sara, Yang Hyungchae, Sumner Jeffrey, Mann Dwayne, Wang Tsai-Yu, Aishah Atqiya, Azarbarzin Ali, Messineo Ludovico, Calianese Nicole, Alex Raichel, Esmaeili Neda, Vanderveken Olivier M, White David P, Wellman Andrew, Huyett Phillip, Sands Scott A
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
D. Vena and S. Op de Beeck made equal contributions to this work as co-first authors.
Eur Respir J. 2025 Oct 7;66(4). doi: 10.1183/13993003.00236-2025. Print 2025 Oct.
Patient selection for hypoglossal nerve stimulation (HGNS) for obstructive sleep apnoea (OSA) requires assessment of pharyngeal site of collapse using drug-induced sleep endoscopy (DISE). The current study aims to address two key knowledge gaps. First, we prospectively confirm that, among HGNS candidates, reduced HGNS efficacy is associated with oropharyngeal lateral wall (OLW) collapse (Aim 1). Second, given DISE is a resource-intensive procedure and delays treatment, we evaluate whether a recently developed non-invasive method for identifying OLW collapse using airflow shapes is associated with reduced HGNS efficacy (Aim 2).
Patients who underwent DISE, HGNS implantation and follow-up sleep testing were included in Aim 1 (n=369) as part of an observational cohort study. For Aim 2, airflow data estimating OLW collapse probability were collected during DISE a pneumotachograph (n=138; DISE Flow cohort) and from a home sleep test (HST) nasal cannula for validation (n=46; HST cohort). Linear regression quantified associations between HGNS efficacy (percent reduction in apnoea-hypopnoea index (AHI)) and DISE-determined OLW collapse (Aim 1) or flow shape-determined OLW collapse (probability score per 2sd) (Aim 2), adjusting for baseline AHI.
Compared to non-OLW collapse, DISE-determined OLW collapse reduced HGNS efficacy by -18.0% (95% CI -31.9- -6.2%). Increased flow shape-determined OLW collapse probability (Δ2sd) was associated with reduced HGNS efficacy in both DISE Flow (-24.8%, 95% CI -40.4- -11.7%) and HST (-22.7%, 95% CI -50.0- -2.6%) cohorts.
This study prospectively validates OLW collapse as a key factor in HGNS failure and shows that airflow-based identification of OLW collapse can effectively estimate HGNS efficacy, representing a significant advancement in patient selection for HGNS.
对于阻塞性睡眠呼吸暂停（OSA）患者，选择舌下神经刺激术（HGNS）需要使用药物诱导睡眠内镜检查（DISE）评估咽部塌陷部位。本研究旨在填补两个关键的知识空白。第一，我们前瞻性地证实，在适合HGNS治疗的患者中，HGNS疗效降低与口咽侧壁（OLW）塌陷有关（目标1）。第二，鉴于DISE是一项资源密集型检查且会延迟治疗，我们评估一种最近开发的利用气流形态识别OLW塌陷的非侵入性方法是否与HGNS疗效降低有关（目标2）。
作为一项观察性队列研究的一部分，目标1纳入了接受DISE、HGNS植入及后续睡眠测试的患者（n = 369）。对于目标2，在DISE期间收集估计OLW塌陷概率的气流数据——使用呼吸流速仪（n = 138；DISE Flow队列），并从家庭睡眠测试（HST）——使用鼻导管进行验证（n = 46；HST队列）。线性回归量化了HGNS疗效（呼吸暂停低通气指数（AHI）降低百分比）与DISE确定的OLW塌陷（目标1）或气流形态确定的OLW塌陷（每2个标准差的概率评分）（目标2）之间的关联，并对基线AHI进行了调整。
与非OLW塌陷相比，DISE确定的OLW塌陷使HGNS疗效降低了18.0%（95%置信区间 -31.9至 -6.2%）。在DISE Flow队列（降低24.8%，95%置信区间 -40.4至 -11.7%）和HST队列（降低22.7%，95%置信区间 -50.0至 -2.6%）中，气流形态确定的OLW塌陷概率增加（Δ2个标准差）均与HGNS疗效降低有关。
本研究前瞻性地验证了OLW塌陷是HGNS治疗失败的关键因素，并表明基于气流的OLW塌陷识别能够有效估计HGNS疗效，这代表了HGNS患者选择方面的重大进展。
