0556 Upper Airway Stimulation:Who are the Patients Really Going for It?

Abstract

Introduction: Upper airway stimulation (UAS) is increasingly recognized as a reliable and safe treatment modality for well-selected patients with moderate-to-severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) failure. This study characterizes patient demographics and their clinical path taken towards UAS in an academic, dedicated sleep surgery clinic. Methods: This study included patients presenting to the Stanford Sleep Surgery clinic who were offered UAS (Inspire, Minnesota, USA) between October 2016-2018. Demographic information, medical history, polysomnography data, and prior treatment history for OSA were collected. For patients seeking UAS, standard drug-induced sleep endoscopy (DISE) examination was performed per routine for UAS selection criteria. Results: Of 131 patients whom UAS was discussed and recommended as a treatment option, 22 underwent UAS (Male: Female 20:2). The mean age was 66.7±8 years, and mean BMI was 26.9±4 kg/M2. Important co-morbidity of this treatment cohort included: 1) 5 with cardiovascular disease, 2) 9 with hypertension, 3) 3 with pulmonary disease, 4) 2 with diabetes mellitus, 5) 2 with renal insufficiency, 6) 1 with stroke, and 7) 1 with acquired immune deficiency syndrome. Eighteen percent of them had relapsed from previous OSA surgery: 2 from soft tissue surgery, and 2 from maxillomandibular advancement. 36% of the treatment cohort also required additional surgery to reverse complete concentric collapse (CCC) of the velum before UAS. Mean reduction in AHI was from 36.4 to 4.3 events/hour. No serious complications were encountered. Conclusion: 17% of all patients offered UAS in a busy academic center offering full-scope sleep surgery elected to undergo UAS. The older age at implantation may reflect both the current insurance climate (easier to approve under Medicare), and the use of UAS after PAP trial and relapse from previous history. Despite the age and high prevalence of co-morbidity important for surgical consideration, patients have done well with UAS. Future studies should focus on both patient and surgeon related factors correlating with the decision and efficacy of undergoing UAS.