1075 Uvulopalatopharyngoplasty Following Hypoglossal Nerve Stimulator Placement For the Treatment of Residual Sleep Apnea

Abstract

Introduction: The use of Hypoglossal Nerve Stimulator (HNS) implantation in the treatment of moderate to severe obstructive sleep apnea (OSA) refractory to or intolerant of non-invasive therapy is increasing in prevalence. Though the efficacy of HNS therapy has been well documented, the possibility of residual sleep disordered breathing (SDB) is possible and the manner in which to proceed under such circumstances is unclear. We present a case of HNS and reconstructive surgery, specifically uvulopalatopharyngoplasty (UPPP), to help resolve a patient's residual SDB symptoms. Report of CAse: This is a 47 y/o male with a history of severe OSA (AHI of 47), Restless legs syndrome (effectively treated with ropinirole therapy) and no other associated comorbidities who was referred to sleep clinic due to his inability to tolerate CPAP therapy in the context of a history of PTSD. Physical exam was significant for a BMI of 29, Mallampati 3 airway with redundant palatal tissue and poor dentition, the latter of which precluded the use of an oral appliance as alternative therapy. The patient would ultimately opt to pursue HNS implantation upon confirmation of his candidacy following sedated endoscopy. Following implantation, the patient would continue to complain of restless sleep, snoring and excessive daytime sleepiness. A subsequent HNS titration study five weeks post-implantation would re-confirm the presence of severe OSA. Despite uptitrating to the maximally tolerated level of 3.2V, obstructive events failed to resolve with an overall AHI of 55. The option of pursuing UPPP as an adjunctive measure was offered and the patient decided to pursue this course of treatment. Upon four week follow up post-UPPP, the patient was seen in clinic and noted dramatic subjective improvement in his sleep, relaying a history of refreshing sleep without nighttime awakenings or snoring. Repeat PSG remains pending as of the time of this publication. Conclusion: The use of HNS and UPPP may be considered as complementary therapies when a patient fails to respond to either intervention alone.