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Comparison of AHI and ESS outcomes between patients with obstructive sleep apnea undergoing sleep surgery versus upper airway stimulation
Objective Palatal or multi-level airway sleep surgery are common options for CPAP-intolerant OSA. Upper Airway Stimulation (UAS) is a recent option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS.
Methods We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. Data are presented as mean and standard deviation.
Results The TSS group (n = 284) and UAS group (n = 541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p < 0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p = 0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p = 0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p < 0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p = 0.01). Using the Sher response criteria, UAS had a 70 % response rate vs 51 % for TSS.
Conclusions This study represents largest and first international, multicenter comparison of UAS to TSS for OSA. While both have similar improvement in symptoms, UAS has a larger reduction of AHI with higher rates of predictable outcomes. However, the authors are aware of certain limitations of the study especially in the TTS group, such as no stratification for different procedures. Careful counseling is critical for patients.
Article published online:
10 June 2020
© 2020. 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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