Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes
Abstract
1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Heinzer, R.; Vat, S.; Marques-Vidal, P.; Marti-Soler, H.; Andries, D.; Tobback, N.; Mooser, V.; Preisig, M.; Malhotra, A.; Waeber, G.; et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. Lancet. Respir. Med. 2015, 3, 310–318. [Google Scholar] [CrossRef]
- Franklin, K.A.; Lindberg, E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J. Thorac. Dis. 2015, 7, 1311–1322. [Google Scholar] [CrossRef] [PubMed]
- Rundo, J.V. Obstructive sleep apnea basics. Clevel. Clin. J. Med. 2019, 86, 2–9. [Google Scholar] [CrossRef] [PubMed]
- Eckert, D.J.; White, D.P.; Jordan, A.S.; Malhotra, A.; Wellman, A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am. J. Respir. Crit. Care Med. 2013, 188, 996–1004. [Google Scholar] [CrossRef]
- Gouveris, H.; Bahr, K.; Schmitt, E.; Abriani, A.; Boekstegers, T.; Fassnacht, S.; Huppertz, T.; Groppa, S.; Muthuraman, M. Corticoperipheral neuromuscular disconnection in obstructive sleep apnoea. Brain Commun. 2020, 2, fcaa056. [Google Scholar] [CrossRef]
- Marin, J.M.; Carrizo, S.J.; Vicente, E.; Agusti, A.G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet 2005, 365, 1046–1053. [Google Scholar] [CrossRef] [PubMed]
- Peppard, P.E.; Young, T.; Palta, M.; Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. New Engl. J. Med. 2000, 342, 1378–1384. [Google Scholar] [CrossRef]
- Seifen, C.; Pordzik, J.; Ludwig, K.; Bahr, K.; Schupp, C.; Matthias, C.; Simon, P.; Gouveris, H. Obstructive Sleep Apnea Disrupts Glycemic Control in Obese Individuals. Medicina 2022, 58, 1602. [Google Scholar] [CrossRef]
- Bahr, K.; Simon, P.; Leggewie, B.; Gouveris, H.; Schattenberg, J. The Snoring Index Identifies Risk of Non-Alcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea Syndrome. Biology 2021, 11, 10. [Google Scholar] [CrossRef]
- Loke, Y.K.; Brown, J.W.; Kwok, C.S.; Niruban, A.; Myint, P.K. Association of obstructive sleep apnea with risk of serious cardiovascular events: A systematic review and meta-analysis. Circ. Cardiovasc. Qual. Outcomes 2012, 5, 720–728. [Google Scholar] [CrossRef]
- Weaver, T.E.; Grunstein, R.R. Adherence to continuous positive airway pressure therapy: The challenge to effective treatment. Proc. Am. Thorac. Soc. 2008, 5, 173–178. [Google Scholar] [CrossRef]
- Qaseem, A.; Holty, J.E.; Owens, D.K.; Dallas, P.; Starkey, M.; Shekelle, P.; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann. Intern. Med. 2013, 159, 471–483. [Google Scholar] [CrossRef]
- Strollo, P.J., Jr.; Soose, R.J.; Maurer, J.T.; De Vries, N.; Cornelius, J.; Froymovich, O.; Hanson, R.D.; Padhya, T.A.; Steward, D.L.; Gillespie, M.B. Upper-airway stimulation for obstructive sleep apnea. N. Engl. J. Med. 2014, 370, 139–149. [Google Scholar] [CrossRef]
- Pordzik, J.; Seifen, C.; Ludwig, K.; Huppertz, T.; Bahr, K.; Matthias, C.; Gouveris, H. Short-Term Outcome of Unilateral Inspiration-Coupled Hypoglossal Nerve Stimulation in Patients with Obstructive Sleep Apnea. Int. J. Environ. Res. Public Health 2022, 19, 16443. [Google Scholar] [CrossRef]
- Steffen, A.; Heiser, C.; Galetke, W.; Herkenrath, S.-D.; Maurer, J.T.; Eck, G.; Woehrle, H.; Löhler, J.; Randerath, W. Die Stimulation des Nervus hypoglossus in der Behandlung der obstruktiven Schlafapnoe–Aktualisiertes Positionspapier der Arbeitsgemeinschaft Schlafmedizin der DGHNO-KHC. Laryngo-Rhino-Otol. 2021, 100, 15–20. [Google Scholar] [CrossRef]
- Kezirian, E.J.; Hohenhorst, W.; de Vries, N. Drug-induced sleep endoscopy: The VOTE classification. Eur. Arch. Otorhinolaryngol. 2011, 268, 1233–1236. [Google Scholar] [CrossRef]
- Belgü, A.U.; Erdoğan, B.; San, T.; Gürkan, E. The relationship between AHI, Epworth scores and sleep endoscopy in patients with OSAS. Eur. Arch. Oto-Rhino-Laryngol. 2015, 272, 241–245. [Google Scholar] [CrossRef]
- Ong, A.A.; Murphey, A.W.; Nguyen, S.A.; Soose, R.J.; Woodson, B.T.; Vanderveken, O.M.; De Vries, N.; Gillespie, M.B. Efficacy of upper airway stimulation on collapse patterns observed during drug-induced sedation endoscopy. Otolaryngol.-Head Neck Surg. 2016, 154, 970–977. [Google Scholar] [CrossRef] [PubMed]
- Mahmoud, A.F.; Thaler, E.R. Outcomes of hypoglossal nerve upper airway stimulation among patients with isolated retropalatal collapse. Otolaryngol. Head Neck Surg. 2019, 160, 1124–1129. [Google Scholar] [CrossRef] [PubMed]
- Xiao, R.; Trask, D.K.; Kominsky, A.H. Preoperative predictors of response to hypoglossal nerve stimulation for obstructive sleep apnea. Otolaryngol. Head Neck Surg. 2020, 162, 400–407. [Google Scholar] [CrossRef] [PubMed]
- Huyett, P.; Kent, D.T.; D’Agostino, M.A.; Green, K.K.; Soose, R.J.; Kaffenberger, T.M.; Woodson, B.T.; Huntley, C.; Boon, M.S.; Heiser, C.; et al. Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulation Outcomes: A Multicenter Cohort Study. Laryngoscope 2021, 131, 1676–1682. [Google Scholar] [CrossRef] [PubMed]
- Wirth, M.; Bautz, M.; von Meyer, F.; Hofauer, B.; Strassen, U.; Heiser, C. Obstruction level associated with outcome in hypoglossal nerve stimulation. Sleep Breath. Schlaf Atm. 2022, 26, 419–427. [Google Scholar] [CrossRef]
- Hohenhorst, W.; Ravesloot, M.; Kezirian, E.; De Vries, N. Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE classification system. Oper. Tech. Otolaryngol. Head Neck Surg. 2012, 23, 11–18. [Google Scholar] [CrossRef]
- Bloch, K.E.; Schoch, O.D.; Zhang, J.N.; Russi, E.W. German version of the Epworth Sleepiness Scale. Respiration 1999, 66, 440–447. [Google Scholar] [CrossRef] [PubMed]
- Huntley, C.; Kaffenberger, T.; Doghramji, K.; Soose, R.; Boon, M. Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: An Evaluation and Comparison of Outcomes at Two Academic Centers. J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med. 2017, 13, 1075–1079. [Google Scholar] [CrossRef][Green Version]
- Heiser, C.; Hofauer, B.; Lozier, L.; Woodson, B.T.; Stark, T. Nerve monitoring-guided selective hypoglossal nerve stimulation in obstructive sleep apnea patients. Laryngoscope 2016, 126, 2852–2858. [Google Scholar] [CrossRef]
- Seay, E.G.; Keenan, B.T.; Schwartz, A.R.; Dedhia, R.C. Evaluation of Therapeutic Positive Airway Pressure as a Hypoglossal Nerve Stimulation Predictor in Patients With Obstructive Sleep Apnea. JAMA Otolaryngol.-Head Neck Surg. 2020, 146, 691–698. [Google Scholar] [CrossRef]
- Edwards, B.A.; Wellman, A.; Sands, S.A.; Owens, R.L.; Eckert, D.J.; White, D.P.; Malhotra, A. Obstructive sleep apnea in older adults is a distinctly different physiological phenotype. Sleep 2014, 37, 1227–1236. [Google Scholar] [CrossRef]
- Lee, C.H.; Seay, E.G.; Walters, B.K.; Scalzitti, N.J.; Dedhia, R.C. Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. J. Clin. Sleep Med. 2019, 15, 1165–1172. [Google Scholar] [CrossRef]
- Landry, S.A.; Joosten, S.A.; Eckert, D.J.; Jordan, A.S.; Sands, S.A.; White, D.P.; Malhotra, A.; Wellman, A.; Hamilton, G.S.; Edwards, B.A. Therapeutic CPAP Level Predicts Upper Airway Collapsibility in Patients With Obstructive Sleep Apnea. Sleep 2017, 40, zsx056. [Google Scholar] [CrossRef]
- Yu, J.L.; Thuler, E.; Seay, E.G.; Schwartz, A.R.; Dedhia, R.C. The Accuracy and Reliability of Visually Assessed Pharyngeal Opening Pressures During Drug-Induced Sleep Endoscopy. Otolaryngol.-Head Neck Surg. 2022. [Google Scholar] [CrossRef] [PubMed]
- Heiser, C.; Edenharter, G.; Bas, M.; Wirth, M.; Hofauer, B. Palatoglossus coupling in selective upper airway stimulation. Laryngoscope 2017, 127, E378–E383. [Google Scholar] [CrossRef] [PubMed]
- Schwartz, R.N.; Payne, R.J.; Forest, V.I.; Hier, M.P.; Fanous, A.; Vallee-Gravel, C. The relationship between upper airway collapse and the severity of obstructive sleep apnea syndrome: A chart review. J. Otolaryngol. Head Neck Surg. 2015, 44, 32. [Google Scholar] [CrossRef]
- Hsu, Y.B.; Lan, M.Y.; Huang, Y.C.; Huang, T.T.; Lan, M.C. The correlation between drug-induced sleep endoscopy findings and severity of obstructive sleep apnea. Auris Nasus Larynx 2021, 48, 434–440. [Google Scholar] [CrossRef] [PubMed]
- Kayamori, F.; Rabelo, F.A.W.; Nazario, D.; Thuller, E.R.; Bianchini, E.M.G. Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: A preliminary study. Sleep Sci. 2022, 15, 95–104. [Google Scholar] [CrossRef]
- Nicholas, C.L.; Jordan, A.S.; Heckel, L.; Worsnop, C.; Bei, B.; Saboisky, J.P.; Eckert, D.J.; White, D.P.; Malhotra, A.; Trinder, J. Discharge patterns of human tensor palatini motor units during sleep onset. Sleep 2012, 35, 699–707. [Google Scholar] [CrossRef]
- Johns, M.W. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993, 103, 30–36. [Google Scholar] [CrossRef]
- Gottlieb, D.J.; Whitney, C.W.; Bonekat, W.H.; Iber, C.; James, G.D.; Lebowitz, M.; Nieto, F.J.; Rosenberg, C.E. Relation of sleepiness to respiratory disturbance index: The Sleep Heart Health Study. Am. J. Respir. Crit. Care Med. 1999, 159, 502–507. [Google Scholar] [CrossRef]
- Hayashida, K.; Inoue, Y.; Chiba, S.; Yagi, T.; Urashima, M.; Honda, Y.; Itoh, H. Factors influencing subjective sleepiness in patients with obstructive sleep apnea syndrome. Psychiatry Clin. Neurosci. 2007, 61, 558–563. [Google Scholar] [CrossRef]
- Mediano, O.; Gonzalez Mangado, N.; Montserrat, J.M.; Alonso-Alvarez, M.L.; Almendros, I.; Alonso-Fernandez, A.; Barbe, F.; Borsini, E.; Caballero-Eraso, C.; Cano-Pumarega, I.; et al. International Consensus Document on Obstructive Sleep Apnea. Arch. Bronconeumol. 2022, 58, 52–68. [Google Scholar] [CrossRef]
- Bausmer, U.; Gouveris, H.; Selivanova, O.; Goepel, B.; Mann, W. Correlation of the Epworth Sleepiness Scale with respiratory sleep parameters in patients with sleep-related breathing disorders and upper airway pathology. Eur. Arch. Otorhinolaryngol. 2010, 267, 1645–1648. [Google Scholar] [CrossRef] [PubMed]
- Chervin, R.D.; Aldrich, M.S.; Pickett, R.; Guilleminault, C. Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test. J. Psychosom. Res. 1997, 42, 145–155. [Google Scholar] [CrossRef] [PubMed]
- Olson, L.G.; Cole, M.F.; Ambrogetti, A. Correlations among Epworth Sleepiness Scale scores, multiple sleep latency tests and psychological symptoms. J. Sleep Res. 1998, 7, 248–253. [Google Scholar] [CrossRef] [PubMed]
- Kapur, V.K.; Baldwin, C.M.; Resnick, H.E.; Gottlieb, D.J.; Nieto, F.J. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep 2005, 28, 472–477. [Google Scholar] [CrossRef]
- Gouveris, H.; Koirala, N.; Anwar, A.R.; Ding, H.; Ludwig, K.; Huppertz, T.; Matthias, C.; Groppa, S.; Muthuraman, M. Reduced Cross-Frequency Coupling and Daytime Sleepiness in Obstructive Sleep Apnea Patients. Biology 2022, 11, 700. [Google Scholar] [CrossRef]
- Heiser, C.; Maurer, J.T.; Hofauer, B.; Sommer, J.U.; Seitz, A.; Steffen, A. Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea in a Multicenter German Postmarket Study. Otolaryngol. Head Neck Surg. 2017, 156, 378–384. [Google Scholar] [CrossRef]
- Kent, D.T.; Carden, K.A.; Wang, L.; Lindsell, C.J.; Ishman, S.L. Evaluation of Hypoglossal Nerve Stimulation Treatment in Obstructive Sleep Apnea. JAMA Otolaryngol. Head Neck Surg. 2019, 145, 1044–1052. [Google Scholar] [CrossRef]
Preoperative | Postoperative | Comparison (p-Value) | |
---|---|---|---|
AHI (n/hour) | 35.58 ± 12.32 | 22.56 ± 13.96 | <0.001 (0.0001) |
Apnea index (n/hour) | 13.54 ± 11.8 | 8.69 ± 11.17 | <0.01 (0.0077) |
Hypopnea index (n/hour) | 22.05 ± 8.32 | 13.88 ± 8.32 | <0.001 (0.0006) |
Snoring index (n/hour) | 244.40 ± 156.5 | 121.98 ± 130.17 | <0.001 (0.00002) |
Oxygen desaturation index (n/hour) | 33.77 ± 15.29 | 27.05 ± 17.13 | <0.01 (0.0084) |
Arousal index (n/hour) | 18.04 ± 7.69 | 12.82 ± 7.15 | <0.01 (0.0071) |
Percentage of Obstruction (%) | |
---|---|
Anteroposterior velar obstruction level | 84.08 ± 15.76 |
Oropharyngeal lateral-wall obstruction level | 16.80 ± 17.43 |
Tongue-base obstruction level | 54.83 ± 17.14 |
AHI Post | AI Post | HI Post | ODI Post | Snoring Index Post | Arousal Index Post | ESS Post | ||
---|---|---|---|---|---|---|---|---|
Anteroposterior velar obstruction | r | −0.29 | −0.01 | −0.5 | −0.28 | −0.11 | −0.37 | −0.31 |
p-value | 0.15 | 0.96 | <0.05 (0.01) | 0.17 | 0.59 | 0.07 | 0.23 | |
Oropharyngeal lateral-wall obstruction | r | 0.33 | 0.25 | 0.14 | 0.32 | 0.42 | 0.21 | 0.19 |
p-value | 0.11 | 0.23 | 0.51 | 0.11 | <0.05 (0.0358) | 0.3 | 0.46 | |
Tongue-base obstruction | r | −0.57 | −0.5 | −0.2 | −0.57 | −0.04 | −0.11 | −0.13 |
p-value | <0.01 (0.0027) | <0.05 (0.0107) | 0.35 | <0.01 (0.0029) | 0.86 | 0.61 | 0.61 |
∆ AHI | ∆ AI | ∆ HI | ∆ ODI | ∆ Snoring Index | ∆ Arousal Index | ∆ ESS | ||
---|---|---|---|---|---|---|---|---|
Anteroposterior velar obstruction | r | 0.04 | 0.14 | 0.13 | −0.1 | −0.17 | 0.13 | 0.21 |
p-value | 0.84 | 0.52 | 0.54 | 0.64 | 0.42 | 0.55 | 0.41 | |
Oropharyngeal lateral-wall obstruction | r | 0.04 | −0.19 | 0.32 | 0.03 | 0.3 | −0.18 | −0.16 |
p-value | 0.85 | 0.37 | 0.12 | 0.87 | 0.15 | 0.39 | 0.54 | |
Tongue-base obstruction | r | 0.58 | 0.54 | 0.2 | 0.54 | −0.12 | 0.35 | −0.42 |
p-value | <0.01 (0.0025) | <0.01 (0.0052) | 0.34 | <0.01 (0.0049) | 0.56 | 0.09 | 0.1 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pordzik, J.; Seifen, C.; Ludwig, K.; Hackenberg, B.; Huppertz, T.; Bahr-Hamm, K.; Matthias, C.; Gouveris, H. Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes. J. Pers. Med. 2023, 13, 532. https://doi.org/10.3390/jpm13030532
Pordzik J, Seifen C, Ludwig K, Hackenberg B, Huppertz T, Bahr-Hamm K, Matthias C, Gouveris H. Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes. Journal of Personalized Medicine. 2023; 13(3):532. https://doi.org/10.3390/jpm13030532
Chicago/Turabian StylePordzik, Johannes, Christopher Seifen, Katharina Ludwig, Berit Hackenberg, Tilman Huppertz, Katharina Bahr-Hamm, Christoph Matthias, and Haralampos Gouveris. 2023. "Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes" Journal of Personalized Medicine 13, no. 3: 532. https://doi.org/10.3390/jpm13030532
APA StylePordzik, J., Seifen, C., Ludwig, K., Hackenberg, B., Huppertz, T., Bahr-Hamm, K., Matthias, C., & Gouveris, H. (2023). Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes. Journal of Personalized Medicine, 13(3), 532. https://doi.org/10.3390/jpm13030532