Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable?
OBJECTIVE
Upper airway stimulation is an effective treatment option for obstructive sleep apnea after failure of positive airway pressure (PAP) therapy. To ensure a therapeutic effect, closed-loop hypoglossal nerve implants require the absence of palatal complete concentric collapse during sleep endoscopy. The frequency and potential predictors of this exclusion criterion are unknown.


METHODS
Over a 2-year period, 74 consecutive patients with sleep apnea who sought PAP alternatives were evaluated with sleep endoscopy using propofol. The influence of sleep apnea severity and anthropometric characteristics as predictors of sleep endoscopy results was investigated.


RESULTS
One-fifth of all patients showed a concentric collapse. Gender and age did not predict the presence of concentric collapse, but higher body mass and apnea hypopnea index values were predictive (p = 0.011; e.g., 0.026). The most commonly used body mass index values for upper airway stimulation indications demonstrated acceptable specificity (BMI 32 kg/m(2) 0.71, 95 % confidence interval = 0.57, 0.82; e.g., 35 kg/m(2) 0.81, 95 % confidence interval = 0.69, 0.90). Despite the association with overweight, a significant number of severely overweight patients had no concentric palatal collapse.


CONCLUSIONS
Concentric collapse is a somewhat common condition encountered in sleep endoscopy evaluations of PAP alternatives, and cannot be sustainably predicted with anthropometric or sleep assessments. Sleep surgeons should be aware of the possibility of concentric collapse, especially in candidates who are more overweight and have severe sleep apnea. Sleep endoscopy can be useful for providing information about continuous positive airway pressure (CPAP) alternatives or to motivate patient adherence to treatment.
Department of Otorhinolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. armin.steffen@uksh.de.|Klinik für HNO-Heilkunde, Ratzeburger Allee 160, 23538, Lübeck, Germany. armin.steffen@uksh.de.
Armin
A
Steffen
Department of Otorhinolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Henning
H
Frenzel
Department of Otorhinolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Barbara
B
Wollenberg
Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Inke R
IR
König
D000328:Adult; D015992:Body Mass Index; D016292:Procedural Sedation; D045422:Continuous Positive Airway Pressure; D004599:Electric Stimulation Therapy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017286:Polysomnography; D015742:Propofol; D019233:Retreatment; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013223:Statistics as Topic; D017211:Treatment Failure
D015742:Propofol
Hypoglossal nerve stimulation; PAP failure; Sleep apnea; Sleep endoscopy; Upper airway stimulation