Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P305

Benefits of Initial Home Sleep Testing to
Direct Upper Airway Stimulation Therapy
Optimization for Obstructive Sleep Apnea
Armin Steffen (Presenter); Inke R. König; Peter M.
Baptista, MD, PhD; Nils Abrams; Stephanie Jeschke; Katrin
Hasselbacher
Objectives: Selective upper airway stimulation (sUAS) is a
well-established treatment option for obstructive sleep apnea.
This study aimed to determine if there are benefits in performing a home sleep test (HST) during the initial sUAS
evaluation compared with the generally used polysomnography (PSG) evaluation, as reflected by long-term follow-up
outcomes.
Methods: We conducted a retrospective cohort analysis of
every consecutive patient at our center who had completed a
6-month follow-up (M6) and recorded data from M6, month
12 (M12), and yearly time points, including month 24 (M24).
During these follow-ups, we performed an HST with the previously used stimulation settings as well as a clinical evaluation with the Epworth Sleepiness Scale (ESS) to evaluate
daytime sleepiness. We also recorded telemetry usage.
Results: Of 133 potential cases, 124 fulfilled the inclusion
criteria and were analyzed. At the 2-month time point of the
HST, the median apnea-hypopnea index (AHI) was 18.5/h
with a range of 0.5 to 67.7/h, whereas at baseline, the median
AHI was 26.0/h with a range of 16.4 to 53.0/h. Nearly half of
the patients (46.2%) reached an AHI ≤15/h, and approximately one-fifth (19.2%) reached less than 5/h. The PSG and
HST groups differed in ESS at M24, but no other differences
were observed for ESS, AHI, oxygen desaturation index, or
usage at M6, M12, or M24.
Conclusions: Adjusting therapy by using the HST technique
during early treatment interventions has clinical and economic
advantages that can be useful as a second-line therapy. However,
these advantages are contingent on several conditions being
met when deviating from the classic adjustment plan, including
precise communication with the follow-up partners to initiate
and maintain therapy optimization adjustments.
Changes of Homocysteine Before and
After Transoral Robotic Surgery-Assisted
Obstructive Sleep Apnea Surgery
Hsin-Ching Lin, MD (Presenter)
Objectives: Untreated obstructive sleep apnea (OSA)/
hypopnea syndrome will increase the risk of cardiovascular
diseases (CVDs). Higher level of homocysteine appreciably
increases cardiovascular events and is an independent CVD
risk factor. The aim of this study was to evaluate the alternation of homocysteine before and after OSA surgery.
Methods: Patients with OSA who failed or refused continuous positive airway pressure or other conservative treatment
and then underwent modified uvulopalatopharyngoplasty

P305
(UPPP) plus transoral robotic surgery (TORS)-assisted OSA
surgery were prospectively reviewed. We obtained pretreatment and posttreatment homocysteine concentrations via
peripheral blood. Patients with other conditions known to
affect homocysteine level were excluded from the study.
Results: A total of 101 patients with OSA (88 men and 13
women; mean age, 45.0 years; mean apnea-hypopnea index,
42.6) with a minimum follow-up of 3 months and complete data
available were enrolled. The mean homocysteine level (µmol/L)
changed from 12.7 ± 5.0 to 11.2 ± 3.4 (P = .0004; paired t test).
There were no perioperative complications or cases of immediate postoperative airway obstruction in this study.
Conclusions: Our study demonstrates that treatment with
modified UPPP plus TORS-assisted OSA surgery for OSA
could have an effect on decreasing the values of homocysteine
concentration.
Combined Ansa Cervicalis and Hypoglossal
Nerve Stimulation Improves Pharyngeal
Patency in Obstructive Sleep Apnea
William C. Scott, MD (Presenter); David L. Zealear, PhD;
David Kent, MD
Objectives: Hypoglossal nerve stimulation (HNS) is an alternative treatment option for obstructive sleep apnea (OSA), but
implant criteria limit patient candidacy. Nonresponders of
HNS frequently demonstrate continued retropalatal and
lateral pharyngeal wall collapse. Tracheal traction is an
important pharyngeal stabilizing mechanism mimicked by
sternothyroid muscle contraction pulling the thyroid cartilage caudally. We evaluated the impact of a combined sternothyroid muscle and hypoglossal neurostimulation on
pharyngeal anatomy.
Methods: Seven subjects with moderate/severe OSA underwent successful ultrasound-guided fine-wire electrical stimulation of the distal hypoglossal nerve and the branch of the ansa
cervicalis nerve plexus innervating the sternothyroid muscle
during drug-induced sleep endoscopy. Airway cross-sectional
area was measured from video still frames with ImageJ.
Results: In 5 patients, combined stimulation during flowlimited inspiration increased retropalatal cross-sectional area
3.05-fold (±1.24; P = .0077) as compared with isolated HNS.
Combined stimulation during inspiration increased retropalatal cross-sectional area 4.57-fold (±0.91; P = .0027) compared
with no stimulation. In 2 patients, fine-wire HNS did not
relieve tongue base obstruction, preventing assessment of
ansa cervicalis effect.
Conclusions: Combined neurostimulation of the sternothyroid muscle and hypoglossal nerve improves retropalatal
patency over isolated HNS via caudal displacement of the distal palate and a reduction in lateral pharyngeal wall collapse.
Confirmation of the ansa cervicalis as a viable neurostimulation target will enable caudal pharyngeal traction as a new surgical treatment vector for OSA.

Sleep Medicine

Poster Presentations

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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