International palate surgery questionnaire.

BACKGROUND: This international study aimed at determining current routine palate surgeries and surgical methods adopted by otolaryngologists who practice surgical management of obstructive sleep apnea (OSA). METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current routines in palatal procedures. The surgeons were asked 33 multiple-choice questions. RESULTS: A total of 141 sleep surgeons answered the questionnaire, of whom 27% were from Africa, 30% from Asia, 24% from Centre-South America, and 19% from Europe. According to otolaryngology surgical specialties, 51% were sleep surgeons, 31% general ENTs, 8% Rhinologists, 7% Head & Neck surgeons, 2% otologists, and 1% maxillofacial surgeons. Of the 141 respondents, 51% answered they were sleep specialists, whereas 49% were non-sleep specialists. According to specific medical degree, 38% were specialists, 33% were consultants, 25% were professors, and 4% were residents or trainees. CONCLUSION: This study gives an overview of the current surgical practice in OSA management in otolaryngology in different countries.

Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology.

PURPOSE: This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). METHODS: The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. RESULTS: The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9 years, with an average Body Mass Index (BMI) of 25.6 kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. CONCLUSIONS: Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary.

Patient-reported outcomes with hypoglossal nerve stimulation for treatment of obstructive sleep apnea: a systematic review and meta-analysis.

INTRODUCTION: Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy. METHODS: A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome. RESULTS: Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p = .010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective. CONCLUSION: HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning.

Pneumothorax during upper airway stimulation: Does experience make a difference?

OBJECTIVES: Upper airway stimulation is a treatment option for select patients with obstructive sleep apnea. Pneumothorax may occur with UAS implantation during placement of the respiratory sensor. This study aims to evaluate the incidence of pneumothorax during UAS device placement. We hypothesize that sleep surgeons with high implantation volumes experience lower rates of pneumothorax compared to the general population of surgeons. METHODS: We also aim to describe management of pneumothorax when it does occur. The incidence of pneumothorax during UAS implantation among the general population of surgeons was assessed using the TriNetX Research Network. Additionally, a select group of Otolaryngologist sleep surgeons with a high UAS implantation volume were surveyed regarding experiences with UAS related pneumothoraces. RESULTS: 8 pneumothoraces occurred among 3823 UAS procedures in the surveyed otolaryngologist sleep surgeon population. 4 required chest tube insertion. Among the general population cohort, 42 of 1233 patients developed pneumothorax after UAS implantation. The rates of pneumothorax between the otolaryngologist sleep surgeon cohort and general population of surgeons cohort were 0.21 % and 3.4 % respectively (p < 0.00001). CONCLUSION: Pneumothorax rarely occurs during UAS implantation. Surgeons with higher implantation volumes showed a lower incidence of pneumothorax. Pneumothorax management is dependent on patient stability, perioperative setting, and degree of injury. The use of needle decompression, chest tube placement, and suture placement also vary with clinical scenario.

Beyond VOTE: The New Frontier of Drug-Induced Sleep Endoscopy.

Alternatives to positive airway pressure therapy, including surgery, represent an important area of research. Specifically, predictors of response to surgical therapy remain underdeveloped. Drug-induced sleep endoscopy (DISE) holds promise as a diagnostic tool to identify patient-specific causes of airway collapse. Herein, we present a novel, standardized approach which combines anatomic and physiologic measurements during DISE. Our DISE platform measures airflow, airway compliance, airway collapsibility, and structural drivers of collapse. Taken together, these inputs provide a comprehensive framework to further inform the surgeon in providing personalized care of the patient with obstructive sleep apnea.

A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS.

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.

Fellow selection protocols in sleep surgery: a national survey of sleep surgery program directors.

PURPOSE: To determine the factors that sleep medicine/surgery fellowship program directors look for in applicants. METHODS: Program directors from 9 sleep medicine/surgery fellowship programs in the USA were sent an anonymous online survey. They were asked to select the five most important academic factors (of a list of 17) when evaluating potential fellowship candidates, then rank those five in order of importance. They were then asked to do the same for the most important subjective criteria (of a list of 12). RESULTS: Eight of 10 survey responses met inclusion criteria. Of the academic factors, strength of letters of recommendation, reputation of letter writer, and letters from sleep surgeons ranked highest. As for the subjective criteria, faculty assessment of the applicant on interview was ranked highest, followed by initiative and personality "fit" with the program. The reputation of an applicant's residency was ranked as more important than the reputation of their medical school. An applicant's performance in residency was assessed as more predictive of their performance in fellowship than performance during the interview process or position on the rank order list for the match. Only one program has a United States Medical Licensing Examination (USMLE) Step, and a different program has an Otolaryngology Training Examination (OTE) score cutoff. CONCLUSION: Letters of recommendation and interview are the most important factors in the selection process for hybrid sleep medicine and surgery fellowship programs, followed by research and residency program reputation. Sleep surgery-specific experience is helpful.

Sleep medicine in otolaryngology units: an international survey.

PURPOSE: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

A systematic approach to the evaluation and management of obstructive sleep apnea: The Jefferson Protocol.

Obstructive sleep apnea (OSA) has become increasingly prevalent in the United States. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treatment, surgical intervention can enhance compliance and improve outcomes for those intolerant of CPAP. Since the majority of OSA patients have multilevel obstruction, it is critical that otolaryngologists understand each patient's pattern and anatomic level of obstruction before solidifying a treatment plan. This publication serves as a comprehensive review of evaluation, characterization, and management of OSA. Further, the authors outline their departmental algorithm for identifying ideal surgical candidates and tailoring corresponding surgical interventions.

Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial.

PURPOSE: The aim of our randomized clinical trial is to produce stronger evidence supporting barbed repositioning pharyngoplasty (BRP) as a therapeutic option for the treatment of obstructive sleep apnea (OSA). METHODS: The trial was a single-center prospective controlled trial with two parallel arms (group A: BRP; group B: observation) and randomization. Baseline and 6-month polygraphy evaluating the apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation (LOS) were performed. To test the differences among groups of Student's t test, the role of each factor (univariate analysis) and their independent effect (multivariate analysis) was explored using logistic regression model as appropriate. Linear regression was also conducted. RESULTS: A significant reduction of AHI, ODI, LOS, and Epworth Sleepiness Scale (ESS) values was recorded in the BRP group. BRP showed to be more effective than observation. Logistic regression showed that preoperative AHI is related significantly to postoperative AHI within the BRP group. A linear regression showed that higher baseline AHI predicts more significant postoperative absolute AHI reduction. CONCLUSIONS: BRP appears to be a promising technique and might be included within the surgical armamentarium of a sleep surgeon. Patients affected by severe OSA may benefit from this surgery with more significant reduction of AHI values.

Effectiveness of sleep surgery versus a mandibular advancement device for obstructive sleep apnea in terms of nocturnal cardiac autonomic activity.

PURPOSE: Sleep surgery and mandibular advancement devices (MAD) are treatments for obstructive sleep apnea (OSA), but their comparative efficacy remains unclear. We compared their efficacy using various parameters. METHODS: Subjects treated for OSA with sleep surgery or MAD (n = 30/group)-matched for sex, body mass index (BMI), and baseline apnea-hypopnea index (AHI)-were enrolled. The efficacy of these treatments according to polysomnographic parameters, sleep quality questionnaires, and heart rate variability (HRV) time- and frequency-domain parameters were compared between pre-treatment and 3-month post-treatment. RESULTS: Polysomnographic and sleep quality questionnaire parameters improved significantly in both groups. In time-domain HRV analysis, average normal-to-normal intervals increased significantly in the surgery (942.2 ± 140.8 to 994.6 ± 143.1, P = 0.008) and MAD (901.1 ± 131.7 to 953.7 ± 123.1, P = 0.002) groups. Low frequency (LF) decreased significantly in the surgery group (P = 0.012); high frequency (HF) remained unchanged in both groups. The LF/HF ratio decreased in both groups (2.9 ± 1.8 to 2.3 ± 1.7, P = 0.017, vs. 3.0 ± 1.8 to 2.4 ± 1.4, P = 0.025). Normalized high frequency increased significantly in both groups (31.0 ± 13.2 to 36.8 ± 13.7, P = 0.009, vs. 29.1 ± 10.7 to 33.7 ± 12.5, P = 0.024), in contrast to normalized low frequency. However, no HRV parameter changes differed significantly between the groups after adjusting for age, BMI, and AHI. CONCLUSION: Sleep surgery and MAD are equally effective treatments for OSA according to cardiac autonomic activity.

Otorhinolaryngology and sleep disorders.

In the field of sleep disorders, otorhinolaryngology is mainly concerned with snoring and obstructive sleep apnea (OSA). Prevalence of OSA is suggested between 14-49 % of male and 5-30 % of female population, which makes it most common sleep disorder. The treatment of choice is positive airway pressure (PAP) therapy with excellent success rate of 90 %, however many patients dont tolerate it. Sleep surgery is usually used to get off snoring and for mild cases of OSA. Most of surgical approaches has much lower effectivity than PAP therapy; however, surgery benefit is present constantly, while PAP therapy demands patients cooperation, that is why many patients still prefer sleep surgery.

YouTube as a source of information for obstructive sleep apnea.

PURPOSE: Assess the quality of information on obstructive sleep apnea (OSA) presented on YouTube for patients. MATERIALS AND METHODS: "Obstructive sleep apnea" was entered into the YouTube search. Two independent reviewers categorized and analyzed videos utilizing a customized scoring-system along with search position, likes, and views. RESULTS: Forty-eight videos were analyzed. Most were educational (52.1%). Educational and news videos had significantly higher scores, but had no significant differences in search position, likes/day, or views/day. Most videos mentioned positive airway pressure (65%), and nearly half (44%) mentioned mandibular devices in the management of OSA. Few videos discussed surgery (13%) or otolaryngology (15%). CONCLUSION: YouTube is a promising source of information for OSA patients. Educational and news videos are of highest quality. General quality measures like search position, views, and likes are not correlated with formally scored value. Sleep surgery and otolaryngologists are minimally mentioned, representing an opportunity for improvement.

Iatrogenic pneumothorax during hypoglossal nerve stimulator implantation.

Hypoglossal nerve stimulation is a promising new treatment for patients with obstructive sleep apnea. In the initial Stimulation Therapy for Apnea Reduction Trial, the overall rate of serious adverse events was <2% and no cases of pneumothorax were reported. We present the case of an iatrogenic pneumothorax during placement of the chest sensor lead between the intercostal muscles. Following clinical and radiological evaluation, surgery was continued and the patient was treated expectantly. In the following review, we discuss pathophysiology, diagnosis, and expected outcomes. Surgeons placing hypoglossal nerve stimulators should be aware of complications and prepared to manage a pneumothorax.

[Sleep endoscopy and complete concentric collapse in CPAP failure]. / Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen.

INTRODUCTION: First-line treatment for patients with obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) therapy. However, many patients cannot use CPAP sufficiently. With drug-induced endoscopy (DISE), it is possible to assess the collapse pattern in the upper airway. The aim of this work was to evaluate a collective of patients with CPAP usage problems using DISE, in order to evaluate their usage problems and therapy recommendations. METHODS: Over a period of 5 years, all patients with an apnea-hypopnea index (AHI) of at least 15/h were retrospectively evaluated using DISE. The recommended treatment options were then analyzed. RESULTS: Data analysis of 210 patients showed that about two thirds reported mask problems as the cause of non-adherence to CPAP. A complete concentric collapse (CCC) could be excluded in 75%. These patients had a lower AHI and more frequent tonsillectomy (TE) than patients with CCC. Double the number of patients with a body mass index (BMI) > 35 kg/m2 had a CCC compared to those with a BMI < 35 kg/m2. Among patients with similar BMI and AHI, CCC was twice as likely to be found in patients without TE. CONCLUSION: The course of treatment recommended for OSA often differs, depending on CCC, BMI > 35 kg/m2, and previous TE.

Israel rake retractor modification to improve exposure during oropharyngeal surgery on patients with larger body habitus.

PURPOSE: Elective oropharyngeal surgery including tonsillectomy and uvulopalatopharyngoplasty performed for obstructive sleep apnea is increasingly performed on patients of larger body habitus. The use of the Crowe-Davis retractor in such patients may be complicated by a large barrel-chest making it difficult to anchor the retractor to the Mayo stand for suspension limiting oropharyngeal exposure. Here, we present a simple modification using the Israel Retractor to facilitate suspension of the Crowe-Davis mouth gag. METHODS: Operational instructions were followed for Israel retractor modification in oropharyngeal surgery. RESULTS: The Crowe-Davis retractor is able to anchor to the Israel retractor, whose prongs articulate on the Mayo Stand for suspension. This extension allows suspension of patients with larger body habitus in oropharyngeal surgery. CONCLUSIONS: Use of the Israel retractor as an extension of the Crowe-Davis retractor handle provides an easy, quick, safe, and reliable method for placing patients of larger body habitus into suspension.

Effects of upper-airway stimulation on sleep architecture in patients with obstructive sleep apnea.

PURPOSE: Selective upper-airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to compare changes in sleep architecture during the diagnostic polysomnography and the post-implantation polysomnography in UAS in patients with OSA. METHODS: Twenty-six patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated 2 and 3 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth sleepiness score (ESS), arousal parameter, and sleep patterns. RESULTS: The mean age was 60.2 years, 25 patients were male, 1 patient was female. Mean BMI was 29.0 kg/m2. The mean pre-implantation AHI of 33.9/h could be reduced to 9.1/h at 2 months post-implantation (p < 0.001). The amount of time spent in N1-sleep could be reduced from 23.2% at baseline to 16.0% at month 3 post-implantation. The amount of time spent in N2- and N3-sleep did not change during the observation period. A significant increase of the amount of REM sleep at month 2 (15.7%) compared to baseline (9.5%; p = 0.010) could be observed. A reduction of the number of arousals and the arousal index could be observed. CONCLUSION: In conclusion, significant changes in sleep architecture of patients with OSA and sufficient treatment with UAS could be observed. A reduction of the amount of time spent in N1-sleep could be caused by treatment with UAS and the rebound of REM sleep, observed for the first time in a study on UAS, is also a potential marker of the efficacy of UAS on sleep architecture. TRIAL REGISTRATION: NCT02293746.

Healthcare usage after uvulopalatopharyngoplasty - Impact of analgesic regimen.

OUTCOME OBJECTIVES: 1) Analyze differences in healthcare usage between subjects receiving different perioperative analgesic medications after uvulopalatopharyngoplasty (UPPP) surgery. 2) Comment on the impact of perioperative analgesic medication on length of hospital stay and complications after UPPP. METHODS: A retrospective cohort study of 120 UPPPs conducted by a single surgeon in the past 5years was conducted. Subjects were grouped based on perioperative pain medication regimen into three groups; narcotics alone (n=83), narcotics with gabapentin (n=27), or narcotics with ketorolac tromethamine (n=10). The primary outcome variable was total number of clinic/emergency room and/or telephone encounters related to post-UPPP pain. Secondary outcomes included length of post-operative hospital stay, number of telephone and/or clinical encounters in which the patient complained specifically of pain or requested a refill for analgesics, and post-operative complications. RESULTS: No significant difference was found between the three analgesic regimens in post-operative hospital stay length (p=0.28, median stay 23.5h), number of clinic or telephone encounters related to pain (p=0.26, mean value 0.71 encounters), or post-operative complication rate (p=0.82, 5.9% complication rate). CONCLUSION: This study shows no significant difference in post-operative healthcare usage between patients with peri-operative analgesic regimens including narcotics alone, gabapentin with narcotics, or ketorolac with narcotics. Post-operative complication rate and length of stay did not differ between groups. These data suggest that these three medication regimens have similar impact on post-operative course for UPPP patients. Therefore, the most affordable or simplest options have equivalent effects on post-operative healthcare usage.

Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis.

The objective is to determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve after transpalatal advancement pharyngoplasty (TPAP) with obstructive sleep apnea (OSA) in adults, using a systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through April 1, 2016. All studies that included patients who underwent TPAP alone were included in this analysis. Fifty-six studies were potentially relevant, 37 were downloaded and five studies met criteria with 199 patients (age: 42.5 ± 9.7 years and body mass index: 29.0 ± 4.0 kg/m2). The grand mean (M) and standard deviation (SD) for AHI (199 patients) pre and post-TPAP decreased from 54.6 ± 23.0 [95 % CI 51.4, 57.8] to 19.2 ± 16.8 [95 % CI 16.9, 21.5] events/h (relative reduction: 64.8 %). Random effects modeling demonstrated a mean difference (MD) of -36.3 [95 % CI -48.5, -24.1], overall effect Z = 5.8 (p < 0.00001), and I 2 = 85 % (significant inconsistency). The standardized mean difference (SMD) for TPAP demonstrated a large magnitude of effect for AHI -1.76 [95 % CI -2.4, -1.1]. For LSAT (70 patients), the pre and post-TPAP M ± SD improved from 81.9 ± 8.1 [95 % CI 80.0, 83.8] to 85.4 ± 6.9 [95 % CI 83.8, 87.0], with a MD of 3.55, overall effect Z = 1.79 (p = 0.07). Thus far, few studies have evaluated transpalatal advancement pharyngoplasty; therefore, we recommend additional studies, especially prospective studies. Research comparing TPAP to pharyngoplasty procedures without palatal advancement would help determine the optimal role for this procedure.

Selective upper airway stimulation for obstructive sleep apnea: a single center clinical experience.

Selective upper airway stimulation (UAS) is a novel therapy for patients with obstructive sleep apnea (OSA). The aim of this study was to analyze the application and outcome of UAS in patients with moderate to severe OSA in the clinical routine of a tertiary referral center. The design of this study is single-center, prospective clinical trial. Thirty-one patients who received a UAS device (Inspire Medical Systems) were included. Treatment outcome was evaluated at 2, 3, 6, and 12 months after surgery. Data collection included demographics, body mass index (BMI), apnea hypopnea index (AHI), oxygen saturation and desaturation index (ODI), Epworth Sleepiness Score (ESS), adverse events, and adherence to therapy. Sher criteria were used to evaluate treatment response. The mean age was 59.6 years with thirty patients being male. Mean BMI was 28.8 kg/m2. The mean pre-implantation AHI of 32.9/h could be reduced to 7.1/h after 12 months (p < 0.001). The mean pre-implantation ODI of 30.7/h could be reduced to 9.9/h after 12 months (p = 0.004). The mean pre-implantation ESS of 12.6 could be reduced to 5.9 after 12 months (p = 0.006). Serious adverse events did not occur. Therapy adherence was a usage of 6.6 h/night after 12 months. OSA severity and subjective daytime sleepiness were improved in patients with moderate to severe OSA after receiving UAS therapy. Patients maintained high adherence to therapy use after 12 months. It is encouraging that UAS has been shown to be successfully implemented in the routine clinical management of OSA outside of a clinical trial setting.