OSA treatment history in an upper airway stimulation trial cohort

Objectives:Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial Methods:Moderate-severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial.Self-reported history on prior OSA medical therapy was collected at enrollment,including OSA diagnosis date,CPAP start and stop dates,oral appliance trial,and reasons for discontinuation or non-adherence.Results:The cohort consisted of 929 participants,83％ male,with a mean age (53.9 ± 10.5) years.Ninety percent (n =835) had complete CPAP information including 47％ (n =435) who discontinued therapy prior to enrollment and 43％ (n =400) who were still attempting CPAP but had inadequate adherence.Abandonment rates were 60％ at 1-year,73％ at 3-years,and 86％ at 5-years.Oral appliance therapy was attempted by 171 patients for mean (1.8 ± 2.3) years,with 81％ abandonment at 1 year,89％ at 3-years,and 94％ at 5-years.Conclusions:In this CPAP-refractory cohort,high rates of CPAP abandonment were reported in the first several years with approximately half of the participants not receiving any treatment despite being diagnosed for ＞5 years.Close clinical follow-up and consideration of alternative treatment options is indicated in all OSA patients in order to ensure adequate longitudinal care.

Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy

Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.

Radiofrequency ablation of the lateral palatal space for snoring

Objective:Pilot study to examine the effect of radiofrequency ablation (RFA) of the lateral palatal fat pad in patients with socially-disruptive snoring.Method:Snoring outcomes and complications were compared between a group of patients with treated with RFA ablation of the lateral soft palate fat pad with or without inferior turbinate reduction (8 patients) and another group undergoing inferior turbinate reduction alone (12 patients).Results:Snoring loudness and bothersomeness improved in the palate but not inferior turbinate group.Pain was mild and no major complications were observed.Conclusion:The study supports RFA ablation of the lateral palatal space as a potential low morbidity procedure for snoring.