Difficulty Falling Asleep is Associated with Poorer Therapeutic Outcomes in Unilateral Hypoglossal Nerve Stimulation.

IF 3 2区医学 Q2 CLINICAL NEUROLOGY Nature and Science of Sleep Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI:10.2147/NSS.S459690

Johannes Pordzik, Katja Petrowski, Katharina Ludwig, Christopher Seifen, Christoph Matthias, Haralampos Gouveris

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Abstract

Purpose: The coexistence of insomnia and obstructive sleep apnea (OSA) is very prevalent. Hypoglossal nerve stimulation (HGNS) is an established second-line therapy for patients suffering OSA. Studies investigating the effect of the different aspects of insomnia on the therapeutic outcome are largely missing. Therefore, this study aimed to understand the impact of the different aspects of insomnia on the therapeutic outcome under HGNS therapy in clinical routine.

Patients and methods: This is a retrospective study including 30 consecutive patients aged 55.40 ± 8.83 years (8 female; 22 male) undergoing an HGNS implantation in our tertiary medical center between 2020 and 2023. All patients underwent preoperative polysomnography (PSG) according to AASM. First follow-up PSG was performed 95.40 ± 39.44 days after activation (30 patients) and second follow-up PSG was performed 409.89 ± 122.52 days after activation (18 patients). Among others, the following PSG-related parameters were evaluated: apnea-hypopnea index (n/h) (AHI) and oxygen desaturation index (n/h) (ODI). Insomnia was assessed by the insomnia severity index (ISI) questionnaire. Preoperatively, all patients included filled out each ISI item. Spearman's-rho correlation coefficient was calculated for correlations.

Results: Preoperative score of ISI item 1 (difficulty falling asleep) was 1.93 ± 1.34 and preoperative cumulative ISI score (item1-7) was 18.67 ± 5.32. Preoperative AHI was 40.61 ± 12.02 (n/h) and preoperative ODI was 38.72 ± 14.28 (n/h). In the second follow-up, the mean difference in AHI was ∆ 10.47 ± 15.38 (n/h) and the mean difference in ODI was ∆ 8.17 ± 15.67 (n/h). Strong significant correlations were observed between ISI item 1 (difficulty falling asleep) and both ∆ AHI (r: -0.65, p=0.004) and ∆ ODI (r: -0.7; p=0.001) in the second follow-up.

Conclusion: Difficulty falling asleep may hence negatively influence HGNS therapeutic outcome. Insomnia-related symptoms should be considered in the preoperative patient evaluation for HGNS.

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入睡困难与单侧舌下神经刺激治疗效果较差有关

目的：失眠和阻塞性睡眠呼吸暂停（OSA）并存的情况非常普遍。舌下神经刺激（HGNS）是治疗 OSA 患者的一种成熟的二线疗法。关于失眠的不同方面对治疗效果的影响的研究在很大程度上是缺失的。因此，本研究旨在了解失眠的不同方面对临床常规 HGNS 治疗结果的影响：这是一项回顾性研究，包括 2020 年至 2023 年期间在本三级医疗中心接受 HGNS 植入术的 30 名连续患者，年龄为 55.40 ± 8.83 岁（8 名女性；22 名男性）。所有患者均根据 AASM 标准进行了术前多导睡眠图检查（PSG）。第一次随访 PSG 在激活后 95.40 ± 39.44 天进行（30 名患者），第二次随访 PSG 在激活后 409.89 ± 122.52 天进行（18 名患者）。除其他外，还评估了以下 PSG 相关参数：呼吸暂停-低通气指数（n/h）（AHI）和氧饱和度指数（n/h）（ODI）。失眠通过失眠严重程度指数（ISI）问卷进行评估。术前，所有患者都填写了 ISI 的每个项目。斯皮尔曼相关系数（Spearman's-rho correlation coefficient）用于计算相关性：术前 ISI 第 1 项（入睡困难）得分为 1.93 ± 1.34，术前 ISI 累计得分（第 1-7 项）为 18.67 ± 5.32。术前 AHI 为 40.61 ± 12.02（n/h），术前 ODI 为 38.72 ± 14.28（n/h）。在第二次随访中，AHI 的平均差异为 ∆ 10.47 ± 15.38（n/h），ODI 的平均差异为 ∆ 8.17 ± 15.67（n/h）。在第二次随访中，观察到 ISI 第 1 项（入睡困难）与 ∆ AHI（r：-0.65，p=0.004）和 ∆ ODI（r：-0.7；p=0.001）之间存在很强的相关性：结论：入睡困难可能会对 HGNS 治疗效果产生负面影响。在对 HGNS 患者进行术前评估时，应考虑与失眠相关的症状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.