Immediate Postoperative Changes After Expansion Pharyngoplasty and Hypoglossal Nerve Stimulation.

Abstract

Objective: Patients with obstructive sleep apnea (OSA) are at an increased risk for perioperative cardiopulmonary complications. Our objective was to assess the postoperative effects of hypoglossal nerve stimulation implantation (HGNS) and expansion pharyngoplasty (EP) on longitudinal sleep apnea measures as a surrogate for respiratory complications.

Study design: Prospective longitudinal cohort study of patients with OSA undergoing HGNS or EP.

Methods: Sleep studies were performed with the NightOwl Mini peripheral arterial tonometry (PAT) device. Changes in apnea-hypopnea index (AHI) and oximetry time below 90% (T90) were assessed between two baseline PAT studies prior to surgery and nightly PAT studies for the first postoperative nights (PON) 1-7, 10, and 14.

Results: Thirty patients were enrolled (19 HGNS, 11 EP). The mean age was 52.6 years, 76.7% were male, and the mean clinical baseline AHI was 29.8/h. There were no significant changes in the AHI or T90 following HGNS implantation. Following EP, there was a statistically significant mean increase in AHI of +19.2/h on PON1, +24.9/h on PON2, and + 20/h on PON3 compared to baseline. T90 was also elevated after EP on PON1, 4, and 5. The mean increase in T90 was +7.4% (95% CI 2.9, 11.9) on PON1 compared to baseline.

Conclusions: In the immediate postoperative period, there were no significant changes in AHI or hypoxemia after HGNS, suggesting that there is no need for routine overnight observation after HGNS. There were significant increases in AHI and hypoxemia after EP suggesting that postoperative disposition should be considered on a case-by-case basis.

Level of evidence: III Laryngoscope, 2024.