Transoral Versus Endoscopic Examination in Predicting Outcomes of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Objectives/Hypothesis To examine the correlation between transoral and awake endoscopic examination and investigate their respective ability to predict outcomes of hypoglossal nerve stimulation (HGNS). Study Design Retrospective cohort study at a US medical center. Methods Subjects were adults with apnea-hypopnea index (AHI) >15 events/hr who underwent HGNS according to standard indications. Eligible subjects had diagnostic preoperative sleep studies, full-night efficacy postoperative studies, as well as postoperative video recordings of transoral examination and awake endoscopy. Recordings were independently scored by two blinded reviewers. Cohen's kappa coefficient, Studentttest, and chi(2)analyses were performed. Results Fifty-seven patients met all inclusion criteria. On average, patients were Caucasian, middle aged, and overweight. The mean preoperative AHI was 36.7 events/hr, which improved significantly to 18.3 events/hr following HGNS (P < .01). Overall, the response rate (defined as AHI reduction >50% and AHI < 20 events/hr) was 49%. There was slight correlation between transoral tongue protrusion and endoscopic tongue base movement (kappa = 0.10). On transoral examination, patients with minimal/moderate tongue motion achieved a greater mean AHI reduction than patients with full motion (26.0 +/- 18.0 vs. 12.8 +/- 24.1,P= .02). In contrast, on awake endoscopy, patients with minimal/moderate tongue motion achieved a lesser mean AHI reduction than patients with full motion (8.7 +/- 19.9 vs. 22.1 +/- 22.7,P= .04). Conclusions Transoral tongue protrusion bears an inverse relationship to HGNS success and correlates poorly with endoscopic tongue base movement. Endoscopic tongue base motion appears reflective of response to HGNS, with greater motion corresponding to greater AHI reduction. Level of Evidence 4Laryngoscope, 2020

Automated summary

This study aims to investigate the correlation between transoral and awake endoscopic examination in predicting outcomes of hypoglossal nerve stimulation. It was found that tongue motion has an impact on the success of HGNS, but the correlation with HGNS outcomes is relatively low.