CC BY-NC-ND 4.0 · Laryngorhinootologie 2019; 98(S 02): S190
DOI: 10.1055/s-0039-1686802
Abstracts
Sleeping Disorders

Changes in Multilevel Airway Dimensions with Upper-Airway Stimulation during Drug-Induced Sleep Endoscopy with Varying Electrode Configurations and Pulse Intensities

D Pawlak
1   UKSH Lübeck/Universität zu Lübeck, Lübeck
,
D Bohorquez
2   Perelman School of Medicine/University of Pennsylvania, Pennsylvania, USA
,
E Thaler
3   Department of Otorhinolaryngology/University of Pennsylvania School of Medicine, Pennsylvania, USA
,
B Wollenberg
4   Klinik für Hals-, Nasen- und Ohrenheilkunde/UKSH Lübeck, Lübeck
,
N Abrams
4   Klinik für Hals-, Nasen- und Ohrenheilkunde/UKSH Lübeck, Lübeck
,
A Steffen
4   Klinik für Hals-, Nasen- und Ohrenheilkunde/UKSH Lübeck, Lübeck
› Author Affiliations
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Introduction:

Selective upper airway stimulation (sUAS) is a novel treatment modality for patients with moderate-to-severe obstructive sleep apnea (OSA) refractory to continuous positive airway pressure (CPAP) therapy. Previous studies have demonstrated that changing electrode configurations (EC) or pulse intensity (PI) can lead to different field currents, affecting airway dimension and therapy success.

The purpose of our study is to quantify how changes in EC and PI influence airway dimensions during drug-induced sleep endoscopy (DISE) in patients who underwent sUAS.

Method:

30 patients with an implanted hypoglossal nerve stimulator underwent DISE in the supine position. The cross-sectional, anterior-posterior, and lateral dimensions at two anatomical levels (retropalatal and retroglossal) were measured at baseline and after stimulation. Airway dimensions were scored by two separate investigators. Patients received PI at 100% of their functional threshold (FT) and 125% FT using three EC – one bipolar (plusminusplus) and two unipolar configurations (minusminusminus, offminusoff).

Result:

To maintain small inter-rater variability in our scoring, 25 of the 30 patients were chosen for analysis. Although we did not observe consistent increases in airway dimension at every level and EC when raising PI from 100% to 125%, we did see at least one EC per patient where increments in PI resulted in larger airway. Comparing all ECs together, 44% of all 25 patients reveal a clear increasement while using the bipolar configuration, followed by the unipolar ones. Individual deviations can be seen.

Conclusion:

We conclude that higher PIs and use of bipolar EC can lead to greater airway dimensions. Despite these findings, adjusting EC and PI may be warranted if a patient is not responding to sUAS therapy.



Publication History

Publication Date:
23 April 2019 (online)

© 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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