Activity

Activity ID

4948

Expires

August 20, 2023

Format Type

Journal-based CME

CME Credit

1

Fee

$30
CME Provider

JAMA Otolaryngology – Head & Neck Surgery

Description
Abstract

Importance:
Recent retrospective hypoglossal nerve stimulation (HGNS) outcomes data suggest that patients with low therapeutic positive airway pressure (PAP) levels achieve greater success than patients with high therapeutic PAP levels.

Objective:
To examine the use of therapeutic nasal PAP levels at the soft palate in predicting the outcomes of HGNS for patients with obstructive sleep apnea.

Design, Setting, and Participants:
This prospective cohort study used drug-induced sleep endoscopy (DISE) to evaluate the predictive capacity of therapeutic PAP levels in HGNS outcomes. In an academic sleep surgery center, 27 consecutive patients with obstructive sleep apnea who underwent DISE before implantation of an HGNS device were evaluated. The study was conducted from May 1, 2018, to June 26, 2019.

Exposures:
Positive airway pressure delivered through a nasal mask during DISE.

Main Outcomes and Measures:
Improvement in apnea-hypopnea index as measured from full-night preoperative and postoperative efficacy studies.

Results:
Twenty-seven patients met all inclusion criteria. The mean (SD) age was 62.0 (14.4) years, 14 participants were men (51.9%), and mean body mass index was 28.1 (4.0). Responders to HGNS therapy (n?=?18) had significantly lower mean (SD) palatal opening pressure compared with nonresponders (n?=?9) (5.0 [2.8] vs 9.2 [3.7] cm H2O, respectively; mean difference, -4.2; 95% CI, -6.8 to -1.6 cm H2O). After adjusting for age, sex, and body mass index, the mean palatal opening pressure value for the responders remained 3.5 cm H2O lower (95% CI, -6.7 to -0.4 cm H2O) than that of nonresponders. A palatal opening pressure cutoff level less than 8 cm H2O demonstrated a positive predictive value of 82.4%; sensitivity, 77.8%; and specificity, 66.7%.

Conclusions and Relevance:
In this small prospective cohort study, therapeutic nasal PAP levels during DISE differed significantly between responder and nonresponders to HGNS. Because DISE represents a mandatory, relatively standardized diagnostic tool for HGNS candidacy, the use of therapeutic nasal PAP through DISE can be broadly implemented and studied across multiple centers to possibly improve patient selection for HGNS.

Disclaimers
1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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More Information
Commercial Support?
No

NOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.

Educational Objectives

To evaluate the use of therapeutic nasal positive airway pressure response during drug-induced sleep endoscopy as a predictor of the success of subsequent hypoglossal nerve stimulation.

Keywords

Head and Neck Surgery, Nasal Surgery, Otolaryngology, Surgery, Sleep Medicine

Competencies

Medical Knowledge

CME Credit Type

AMA PRA Category 1 Credit

Additional Information

doi:10.1001/jamaoto.2020.1018

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