Author(s)
Ian L. Sunyecz, DO
Ryan Ziltzer, MD
Ruifeng Cui, PhD
Edward Rojas, MD
Monika Freiser, MD
Chadi Makary, MD
Affiliation(s)
West Virginia University
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to question if postoperative hypoglossal nerve stimulator titration sleep studies are the best method to assess for overall OSA efficacy.
Objectives: Hypoglossal nerve stimulator (HNS) therapy is a commonly used treatment option for obstructive sleep apnea. Treatment efficacy is typically measured by the apnea-hypopnea index (AHI) at optimum voltage established during the postoperative multi-amplitude titration polysomnogram (tPSG). However, patients often end up using voltages that are different from their optimum voltage. This study investigated and compared the outcome of HNS based on the voltages used by patients after their titration study versus their optimal recommended voltage.
Study Design: A single institution retrospective cohort study examining patients who underwent HNS implantation from March 2017-July 2024.
Methods: Baseline demographics and pre and postoperative PSG and voltages were reviewed.
Results: Out of 110 HNS implants performed, 44 patients (mean age of 62.8 years; 31.8% female) had followup data. At the postoperative tPSG, the average AHI at optimum voltage was 6.2 events/hr and the average overall AHI was 15.3 events/hr. Both were significantly improved compared to their preoperative average AHI of 31.5 (p<0.01 for all). However, at their followup, patients were found to be using voltages that were significantly lower than their recommended optimal voltage (1.59 vs 1.77; p<0.01). The corresponding average AHI for the voltages being used was 25.2 events/hr which was not significantly different than the preoperative AHI of 31.5 (p=0.082).
Conclusions: Patients who underwent HNS implantation are often using voltages that are significantly lower than recommended which corresponded to no significant AHI improvement from preop. This highlights the need for further postoperative evaluations and additional sleep studies.