Medical Student Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania
Educational Objective: At the conclusion of this presentation, the participants should be able to determine if palatal coupling maneuvers during drug induced sleep endoscopy can predict treatment efficacy of the hypoglossal nerve stimulator.
Objectives: For obstructive sleep apnea (OSA), maneuvers during drug induced sleep endoscopy (DISE) have been used as predictors for success with oral appliances. The hypoglossal nerve stimulator (HGNS) promotes opening at the velum through palatoglossus coupling. In this study, we evaluate the use of palatal coupling maneuvers during DISE as predictors for HGNS treatment efficacy. Study Design: Retrospective observational.
Methods: Patients underwent HGNS surgery between November, 2014, and February, 2021. Patients received preoperative DISE during which palatal coupling maneuvers including jaw thrust and chin lift were rated on a scale of 1 to 4 at the velum and tongue base (1: no improvement, 2: mild improvement, 3: moderate improvement, 4: significant improvement). Patients were included if they had a sleep study before and after surgery. Patients were grouped by a score of 1-2 (weak response) or 3-4 (strong response). Apnea hypopnea index (AHI) change was calculated based on the difference between preoperative and postoperative sleep study.
Results: 171 patients were included. On jaw thrust, there was no significant difference in AHI change between patients with weak or strong response at the velum (n=68 vs. 94, 9.5 vs. 14.2, p=0.15) 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 velum (n=82 vs. 26, 13.9 vs. 11.4, p=0.63) or tongue base (n=92 vs. 72, 10.8 vs. 14.6, p=0.24).
Conclusions: Palatal coupling maneuvers during DISE were not predictive of treatment success with the HGNS. Our study suggests that findings using these maneuvers should not preclude HGNS candidacy.