The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis

Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for alternative therapies.Upper airway surgery is one alternative,but substantial side effects hamper efficacy.A new alternative is an implantable hypoglossal nerve stimulator (HNS).These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery.Several recent trials investigated the efficacy of these devices.The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.Methods:A comprehensive literature search of PubMed and Scopus was performed.Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults.Studies with objective and subjective endpoints in sleep were included for analysis.Adverse events from trials were also recorded.Results:Across 16 studies,381 patients were analyzed.At 6 months (p =0.008),mean SAQLI improved by 3.1 (95%CI,2.6-3.7).At 12 months (p < 0.0001),mean AHI was reduced by 21.1 (95%Cl,16.9-25.3),mean ODI was reduced by 15.0 (95%CI,12.7-17.4),mean ESS was reduced by 5.0 (95%CI,4.2-5.8),mean FOSQ improved by 3.1 (95%CI,2.6-3.4).Pain (6.2%:0.7-16.6),tongue abrasion (11.0%:1.2-28.7),and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events.Conclusions:HNS is a safe and effective treatment for CPAP refractory OSA.Further study comparing HNS to other therapies is required.

Predictors of occult lymph node metastasis in cutaneous head and neck melanoma

Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.