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Can initial home sleep testing help direct the course of therapy optimization using Upper Airway Stimulation for obstructive sleep apnea?
Selective upper airway stimulation (sUAS) is a treatment option for CPAP-intolerant obstructive sleep apnea. The current treatment algorithm is for patients to self-adjust stimulation in the home setting for 2-3 months, followed by in-laboratory polysomnography (PSG). However, in-lab PSG availability is limited by sleep lab capacity and patient ability to travel. In the past 2 years, we have utilized 2-month home sleep tests (M2 HST) as an initial therapy progress check, followed by an in-laboratory titration 6-months after implant.
The study enrolled patients who had both baseline and M2 HST results after UAS implantation (n = 43). We retrospectively analysed the 2-month AHI response (based on the Sher-15 criteria of at least 50 % AHI reduction to 15/h) and follow-up actions. At 2-month, the amplitude was increased from activation visit by 0.6 ± 0.7 volts. 72 % of patients (21/29) had an amplitude greater than their activation visit at 1-month.
After the M2 HST, 49 % (21/43 patients) met the Sher-15 criteria with average AHI 6.8 ± 3.5/h, while the rest had an AHI 19.8 ± 15.5/h.
For the Sher-15 responders, the most common action was to continue the patient through next follow-up without any programming change (62 %). For the Sher-15 non-responders, the two most common actions were DISE with stimulation and/or device reprogramming (27 % each). Approximately 50 % of patients may have self-titrated in the home setting to an effective AHI, prior to a PSG titration, as measured by M2 HST. HST in the post-activation phase can provide early information about patient response to therapy, and may help with actions that will further improve patient response. PSG may be useful for device adjustments after preliminary HST for patients who have not yet self-titrated to an effective amplitude.
Article published online:
10 June 2020
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Stuttgart · New York