Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?

Autor: Alapati R; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA. ralapati@kumc.edu., Wang N; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Feucht M; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Ramesh U; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Bon Nieves A; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Arambula A; Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH, USA., Renslo B; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA., Lawrence A; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Wagoner SF; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Rouse D; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA., Larsen C; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3010, Kansas City, KS, 66103, USA.
Jazyk: angličtina
Zdroj: Sleep & breathing = Schlaf & Atmung [Sleep Breath] 2024 Nov 25; Vol. 29 (1), pp. 6. Date of Electronic Publication: 2024 Nov 25.
DOI: 10.1007/s11325-024-03174-2
Abstrakt: Purpose: Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Methods: Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2-6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
Results: 327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (β = 3.7, CI [1.3, 7.4], p = 0.038) and increased age (β = 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
Conclusions: UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.
Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Kansas Medical Center and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approved by the University of Kansas Medical Center IRB. Conflicts of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
(© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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