0571 Comparison Of Ahi And Ess Outcomes Between Patients Undergoing Palatal Surgery Versus Upper Airway Stimulation Adhere Registry. (12th April 2019)

• Record Type: Journal Article
• Authors: Heiser, Clemens; Shah, Janki; Kominsky, Alan H; Hofauer, Benedikt; Huntley, Colin; Boon, Mau; Mulvey, Carolyn; Hoff, Paul T; Thaler, Erica
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A227
• Page End: A228
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.569
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: CPAP intolerance occurs in 30-50% of obstructive sleep apnea patients, and some seek surgical alternatives. Palatal surgery is a common alternative. Upper Airway Stimulation (UAS), using an implantable hypoglossal nerve stimulator is another recent option. We retrospectively compared post-operative outcomes between the two methods. Methods: Palatal surgery (PS) was defined as either uvulopalatopharyngoplasty or expansion pharygoplasty. Patients who underwent palatal surgery, and would have met general UAS criteria (BMI ≤35 and AHI between 15-65) were selected for chart review. UAS outcomes were collected from the ADHERE multi-center international registry. Demographics, baseline and post-operative outcomes were compared. Data are presented as mean and standard deviation. Results: (90% vs 76%), and overweight (PS-BMI: 29 ± 3 vs. UAS-BMI: 29 ± 4, p=0.50). The palatal surgery cohort was younger than the UAS cohort (46 ± 11 vs 61 ±11 years, p<0.001), perhaps reflecting concerns of airway surgery post-operative complications in an older population. At baseline, both cohorts had severe, symptomatic OSA. PS patients had a non-significant trend towards lower pre-op AHI than UAS. (PS-Baseline AHI: 33 ± 13 vs UAS-Baseline AHI:36 ± 16, p=0.09). Baseline ESS were similar (PS-ESS: 11 ± 5 vs. UAS-ESS: 12 ± 5, p=0.31). After similar follow-up intervals (153 ±106 vs 147 ± 95days, p=0.74), UAS recipients had a significantly larger decrease in AHI than the PS group (-25 ±18 events/hour vs. -15 ± 17events/hour, p<0.00001). UAS recipients also had a slightly larger decrease in ESS, (-4 ± 5vs -3 ± 5), but the difference was not statistically significant (p=0.12). Using the Sher surgical success criteria (50% decrease in AHI and ≤20 events/hour), UAS had a 75% success rate vs 52% palatal surgery success. Conclusion: Despite similar baseline disease severity and demographics, UAS reduces the AHI significantly more than palatal surgery, and with a higher surgical success rate. ESS was equally reduced by both therapies. These findings warrant further prospective research. Support (If Any): This clinical trail (ADHERE registry) is supported by Inspire Medical Systems