title: Efficacy of Upper Airway Stimulation on Collapse Patterns Observed during Drug-Induced Sedation Endoscopy.
abstract: To describe upper airway collapse patterns observed on drug-induced sedation endoscopy (DISE) during screening for a clinical trial and to evaluate the impact of collapse patterns found on preoperative DISE on response rates to upper airway stimulation (UAS) therapy.
  
  
  
  Retrospective review of an ongoing prospective multi-institutional cohort study.
  
  
  
  Twenty-two participating institutions of the STAR trial.
  
  
  
  In total, 222 subjects were screened with DISE to determine eligibility for an implantable UAS device. Supine laryngoscopy was performed during moderate sedation (propofol and/or midazolam). Airway collapse pattern and severity were graded at 4 levels, including velum, oropharynx, tongue base, and epiglottis (VOTE classification). Patients with complete concentric collapse (CCC) at the velum were excluded from implantation.
  
  
  
  The CCC at the velum was observed in 52 (23%) of screened subjects, and these subjects were subsequently excluded from implantation. Of the 170 subjects without CCC at the velum, 126 (77%) underwent implantation: 121 (96%) had multilevel collapse and 5 (4%) had single-level collapse. When comparing preimplantation DISE findings, UAS responders at 12 months had lower baseline VOTE scores compared with therapy nonresponders.
  
  
  
  Drug-induced sedation endoscopy is an efficient and safe method for determining UAS eligibility and has the potential to identify UAS nonresponders. Most patients had multilevel airway collapse, illustrating the limitations of single-level upper airway surgery in treating obstructive sleep apnea. Upper airway stimulation is effective therapy for most patients with multilevel airway collapse; however, patients with complete anterior-posterior or lateral soft palate and/or epiglottic collapse may be at increased risk of therapy failure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA onga@musc.edu.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Ong
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Murphey
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.affiliation: Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Soose
authors.affiliation: Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: B Tucker
authors.initials: BT
authors.lastname: Woodson
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanderveken
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Belgium Department of Otorhinolaryngology-Head and Neck Surgery, Saint Lucas Andreas Hospital, Amsterdam, the Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D058542:Implantable Neurostimulators; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives
keywords: drug-induced sedation endoscopy; drug-induced sleep endoscopy; obstructive sleep apnea; sedation; sleep surgery; sleep-disordered breathing; upper airway stimulation