Upper airway stimulation in obstructive sleep apnea – can radiological cuff control predict tongue movement?

Introduction:

Recently upper airway stimulation (UAS) has become established as a second-line therapy to treat obstructive sleep apnea, for a selected patient clientele.

It is known that certain tongue movement patterns under stimulation are associated with a better response to therapy. In our monocentric study, we wanted to investigate whether the position of the stimulation cuff in the postoperative X-ray control, allows a prediction of the tongue movement.

Method:

Since to date, there are no validated guidelines for a description of the position of the cuff, various aspects such as proximity to the mandible or distance to the hyoid have been investigated dichotomously. Three different raters were utilised for this evaluation.

12 months postop, a follow-up was made to exclude the effects of healing. Here, the categorized tongue movement in the electrode configuration, with the smallest electric field, was used.

Results:

All three raters, with different amounts of experience in UAS therapy, evaluated the cuff position in 36 patients similarly and with good decision-making reliability. From the five categories used however, no good prediction about the tongue movement was possible.

Conclusion:

From the postoperative radiological control, no prediction of tongue movement in a bipolar configuration could be made, with a comprehensible assessment catalog. This aspect can therefore not be used to predict a particularly good or even critical recruitment process, especially with regard to increasingly networked patients. The clincal control has its unchanged significance in order to be able to assess dislocations as a starting point for possible problems.

Publication History

Publication Date:
18 April 2018 (online)