Combination Tonsillectomy and Hypoglossal Nerve Stimulation for Sleep Apnea Patients With Oropharyngeal Lateral Wall Collapse.

IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2024-12-01 Epub Date: 2024-08-27 DOI:10.1002/ohn.950
Phillip Huyett, Andrew Wellman, Victoria Caruso, Jeffrey Sumner, Atqiya Aishah, Ali Azarbarzin, Scott Sands, Daniel Vena
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Abstract

Objective: The efficacy of hypoglossal nerve stimulation (HGNS) therapy is limited by obstruction of the oropharyngeal lateral walls (OLWs). Our objective was to investigate the effect of palatine tonsillectomy on HGNS efficacy in obstructive sleep apnea (OSA) patients with OLW collapse.

Study design: Case-control study of patients with moderate-to-severe OSA, complete-or-partial OLW collapse, and small tonsils (1 - 2+). Concomitant palatine tonsillectomy and HGNS (HGNS+T) were compared against a control group of patients who underwent HGNS alone.

Setting: Single academic institution.

Methods: Study outcomes were measures of HGNS efficacy defined as a %reduction in apnea-hypopnea index (AHI) (primary) and successful treatment response (50% AHI reduction to <15/h, logistic regression), respectively. Regression analyses quantified the additional effect of tonsillectomy (HGNS+T vs HGNS alone, independent variable) on HGNS efficacy. Analyses were adjusted for OLW collapse severity (complete vs partial), tonsil size, age, sex, body mass index, and baseline AHI.

Results: Nineteen patients underwent HGNS+T and had follow-up sleep testing for the current analysis. The control group (HGNS alone) consisted of 78 patients. Baseline demographics and OSA severity were similar between the groups, except HGNS+T group had increased prevalence of complete OLW collapse. Linear regression demonstrated that adding tonsillectomy resulted in an additional 22.9% [7.5, 35.2] reduction in AHI [95% confidence interval, CI] (P = .006), and 8.6 [1.7,43.4] (P = .010) greater odds [95% CI] of a successful treatment response with HGNS.

Conclusion: Compared to historically poorer outcomes of HGNS in patients with OLW collapse, these early results suggest combining tonsillectomy with HGNS may represent a promising strategy to improve success rates.

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合并扁桃体切除术和舌下神经刺激术治疗口咽侧壁塌陷的睡眠呼吸暂停患者
目的:舌下神经刺激(HGNS)疗法的疗效因口咽侧壁(OLW)阻塞而受到限制。我们的目的是研究腭扁桃体切除术对口咽侧壁塌陷的阻塞性睡眠呼吸暂停(OSA)患者的舌下神经刺激疗法疗效的影响:病例对照研究:研究对象为中重度 OSA、OLW 完全或部分塌陷、扁桃体较小(1 - 2+)的患者。将同时接受腭扁桃体切除术和 HGNS(HGNS+T)的患者与仅接受 HGNS 的对照组患者进行比较:地点:单个学术机构:研究结果:HGNS疗效是指呼吸暂停-低通气指数(AHI)降低的百分比(主要指标)和成功的治疗反应(AHI降低50%):19 名患者接受了 HGNS+T 治疗,并在本次分析中接受了后续睡眠测试。对照组(仅接受 HGNS 治疗)有 78 名患者。两组患者的基线人口统计学特征和 OSA 严重程度相似,但 HGNS+T 组患者的 OLW 完全塌陷发生率更高。线性回归结果显示,增加扁桃体切除术可使 AHI 降低 22.9% [7.5, 35.2] [95% 置信区间,CI] (P = .006),HGNS 治疗成功的几率增加 8.6 [1.7, 43.4] (P = .010)[95%CI]:这些早期结果表明,将扁桃体切除术与 HGNS 相结合可能是提高成功率的一种有前途的策略。
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来源期刊
Otolaryngology- Head and Neck Surgery
Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学
CiteScore
6.70
自引率
2.90%
发文量
250
审稿时长
2-4 weeks
期刊介绍: Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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