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Drug-Induced Sleep Endoscopy May Have Broader Role in Evaluating OSA Patients for Hypoglossal Nerve Stimulation

by Linda Kossoff •

What is the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) and outcomes of hypoglossal nerve stimulation (HNS) for obstructive sleep apnea (OSA)?

BOTTOM LINE

The role for DISE in counseling candidates for HNS extends beyond excluding complete concentric collapse related to the velum.

BACKGROUND: Hypoglossal nerve stimulation is an approved treatment for certain patients with moderate to severe OSA. Due to findings associating concentric collapse at the velopharynx with worse outcomes for some patients, use of DISE criteria is a mandatory component of HNS preoperative evaluation. However, preoperative DISE findings have not demonstrated consistent associations with HNS outcomes.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.

SYNOPSIS: Researchers performed a retrospective, multicenter cohort study of 343 adults (258 men, 85 women, baseline age 60.4 years) with OSA who had a video-recorded preoperative DISE, responded successfully to HNS, and received postoperative titration polysomnography (tPSG). Average BMI was 29.2 and average apnea–hypopnea index (AHI) 35.6. The DISE videos were blind reviewed according to the VOTE classification for scoring airway structure collapse. Associations between individual DISE findings and surgical outcomes were tested. The tPSG showed AHI decreases (72.6% response rate); home sleep apnea test response rates were notably lower. Tongue-related obstruction was most clearly associated with increased odds of HNS response, largely in patients with higher preoperative BMI. Within this subgroup, those with complete tongue-related obstruction had an 81% response rate. Oropharyngeal lateral wall obstruction was associated with poorer outcomes; epiglottis-related obstruction had the lowest response rates. There was no statistically significant association between outcomes and complete concentric collapse related to the velum, although few participants had this DISE finding. Authors concluded that the role for DISE in counseling candidates for HNS extends beyond velum-related complete concentric collapse. Study limitations included use of AHI as the primary measure of outcome and the known subjectivity of DISE and the VOTE classification.

CITATION: Huyett P, Kent DT, D’Agostino MA, et al. Drug-induced sleep endoscopy and hypoglossal nerve stimulation outcomes: A multicenter cohort study. Laryngoscope. 2021;131:1676-1682.