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Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable?

  • ENT • Original Article
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Abstract

Purpose

Upper airway stimulation is an effective treatment option for obstructive sleep apnea after failure of positive airway pressure (PAP) therapy. To ensure a therapeutic effect, closed-loop hypoglossal nerve implants require the absence of palatal complete concentric collapse during sleep endoscopy. The frequency and potential predictors of this exclusion criterion are unknown.

Methods

Over a 2-year period, 74 consecutive patients with sleep apnea who sought PAP alternatives were evaluated with sleep endoscopy using propofol. The influence of sleep apnea severity and anthropometric characteristics as predictors of sleep endoscopy results was investigated.

Results

One-fifth of all patients showed a concentric collapse. Gender and age did not predict the presence of concentric collapse, but higher body mass and apnea hypopnea index values were predictive (p = 0.011; e.g., 0.026). The most commonly used body mass index values for upper airway stimulation indications demonstrated acceptable specificity (BMI 32 kg/m2 0.71, 95 % confidence interval = 0.57, 0.82; e.g., 35 kg/m2 0.81, 95 % confidence interval = 0.69, 0.90). Despite the association with overweight, a significant number of severely overweight patients had no concentric palatal collapse.

Conclusions

Concentric collapse is a somewhat common condition encountered in sleep endoscopy evaluations of PAP alternatives, and cannot be sustainably predicted with anthropometric or sleep assessments. Sleep surgeons should be aware of the possibility of concentric collapse, especially in candidates who are more overweight and have severe sleep apnea. Sleep endoscopy can be useful for providing information about continuous positive airway pressure (CPAP) alternatives or to motivate patient adherence to treatment.

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References

  1. Nilius G, Cottin U, Domanski U, van’t Hoog T, Franke KJ, Burian S, Ruehle KH (2012) Effects of intensive outpatient training on the adherence of CPAP therapy for patients with OSA. Somnologie 16:251–256

    Article  Google Scholar 

  2. Verse T, Bodlaj R, de la Chaux R, Dreher A, Heiser C, Herzog M, Hohenhorst W, Hörmann K, Kaschke O, Kühnel T, Mahl N, Maurer JT, Pirsig W, Rohde K, Sauter A, Schedler M, Siegert R, Steffen A, Stuck BA, Schlafmedizin AG, ArGe Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (2009) Guideline: treatment of obstructive sleep apnea in adults. HNO 57:1136–1156

    Article  CAS  PubMed  Google Scholar 

  3. Randerath WJ, Steffen A (2014) Treatment alternatives to positive airway pressure in obstructive sleep apnoea. EMJ 68:106–123

    CAS  Google Scholar 

  4. Maurer JT, Van de Heyning P, Lin HS, Baskin J, Anders C, Hohenhorst W, Woodson BT (2012) Operative technique of upper airway stimulation - an implantable treatment of obstructive sleep apnea. Oper Tech Otolaryngol Head Neck Surg 23:227–233

    Article  Google Scholar 

  5. Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, Hohenhorst W, Knaack L, Lin HS, Maurer JT, Netzer A, Odland RM, Oliven A, Strohl KP, Vanderveken OM, Verbraecken J, Woodson BT (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122:1626–1633

    Article  PubMed  Google Scholar 

  6. Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, Van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP; STAR Trial Group (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370:139–149

    Article  CAS  PubMed  Google Scholar 

  7. Woodson BT, Gillespie BM, Soose RJ, Maurer JT, de Vries N, Steward DL, Baskin JZ, Padhya TA, Lin HS, Mickelson S, Badr SM, Strohl KP, Strollo PJ (2014) Randomized controlled withdrawal study of upper airway stimulation on OSA: short and long term effect. Otolaryngol Head Neck Surg 151:880–887

    Article  PubMed  Google Scholar 

  8. Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9:433–438

    PubMed Central  PubMed  Google Scholar 

  9. De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18:453–465

    Article  PubMed  Google Scholar 

  10. Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN (2010) Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 136:393–397

    Article  PubMed  Google Scholar 

  11. Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ (2009) Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140:646–651

    Article  PubMed Central  PubMed  Google Scholar 

  12. Vroegop AV, Vanderveken OM, Wouters K, Hamans E, Dieltjens M, Michels NR, Hohenhorst W, Kezirian EJ, Kotecha BT, de Vries N, Braem MJ, Van de Heyning PH (2013) Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep 36:947–953

    PubMed Central  PubMed  Google Scholar 

  13. Hong SD, Dhong HJ, Kim HY, Sohn JH, Jung YG, Chung SK, Park JY, Kim JK (2013) Change of obstruction level during drug-induced sleep endoscopy according to sedation depth in obstructive sleep apnea. Laryngoscope 123:2896–2899

    Article  PubMed  Google Scholar 

  14. Lee CH, Kim DK, Kim SY, Rhee CS, Won TB (2015) Changes in site of obstruction in obstructive sleep apnea patients according to sleep position: a DISE study. Laryngoscope 125:248–254

    Article  PubMed  Google Scholar 

  15. Eichler C, Sommer JU, Stuck BA, Hörmann K, Maurer JT (2013) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 17:63–68

    Article  PubMed  Google Scholar 

  16. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236

    Article  PubMed  Google Scholar 

  17. Kezirian EJ (2011) Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope 121:1320–1326

    Article  PubMed Central  PubMed  Google Scholar 

  18. Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, Van de Heyning PH, Hamans E (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 124:797–802

    Article  PubMed  Google Scholar 

  19. Safiruddin F, Vanderveken OM, de Vries N, Maurer JT, Lee K, Ni Q, Strohl KP (2015) Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions. Eur Respir J 45:129–138

    Article  PubMed  Google Scholar 

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Acknowledgments

Armin Steffen, a study investigator, received an honorarium for giving invited talks for Inspire Medical, Inc., outside the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Armin Steffen, Henning Frenzel & Barbara Wollenberg

  2. Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Inke R. König

  3. Klinik für HNO-Heilkunde, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Armin Steffen

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  1. Armin Steffen
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  2. Henning Frenzel
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  3. Barbara Wollenberg
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  4. Inke R. König
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Correspondence to Armin Steffen.

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Steffen, A., Frenzel, H., Wollenberg, B. et al. Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable?. Sleep Breath 19, 1373–1376 (2015). https://doi.org/10.1007/s11325-015-1277-9

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  • DOI: https://doi.org/10.1007/s11325-015-1277-9

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