Dataset Information

Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea.

ABSTRACT: STUDY OBJECTIVES:To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system. METHODS:A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined with a Neurometer current perception threshold (CPT) system. The system was used to deliver an electrical stimulus at three different frequencies (2,000 Hz, 250 Hz, and 5 Hz) by an investigator blinded to the PSG results. RESULTS:There were no significant differences in the CPT values of the hard palate between the patients with OSA and control patients at any of the three stimulation frequencies. The differences in the CPT values of the soft palate between these groups failed to show any statistical significance at 250 Hz and 5 Hz. However, the patients with OSA showed significantly higher CPT values of the soft palate at 2,000 Hz than the age-matched healthy control patients (256.56 ± 129.34 versus 372.13 ± 152.06; P = .009). CONCLUSIONS:Our study revealed an impairment of 2,000 Hz-related sensory nerve function of the soft palate among patients with OSA. The CPT test could be a useful tool for the quantitative and selective assessment of the sensory nerve function in patients with OSA. Additional research is required to evaluate the different types of sensory nerve dysfunctions among such patients. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov; Title: The Effects of Nasal Airflow on Upper Airway Dilator Muscles During Sleep; Identifier: NCT03506178; URL: https://clinicaltrials.gov/ct2/show/NCT03506178. CITATION:An Y, Li Y, Chang W, Gao F, Ding X, Xu W, Han D. Quantitative evaluation of the function of the sensory nerve fibers of the palate in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(9):1347-1353.

SUBMITTER: An Y

PROVIDER: S-EPMC6760391 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea.

An Yunsong Y Li Yanru Y Chang Wei W Gao Fei F Ding Xiu X Xu Wen W Han Demin D

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 20190901 9

<h4>Study objectives</h4>To quantitatively evaluate the functional integrity of sensory nerve fibers of the palate in patients with obstructive sleep apnea (OSA) using the Neurometer system.<h4>Methods</h4>A total of 32 patients with OSA and 18 healthy control patients were included in the study. All participants were selected based on medical history, physical examination, and nocturnal polysomnography (PSG) and divided into two groups. The palatal sensory status of participants was examined wi ...[more]

PMID: 31538606

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Project description:Importance:Hypoglossal nerve stimulation is a treatment option for patients with obstructive sleep apnea unable to tolerate continuous positive airway pressure. This study evaluates demographic factors that may be associated with greater improvements in postoperative outcomes of interest. Objective:To examine the association of hypoglossal nerve stimulation with obstructive sleep apnea severity, daytime sleepiness, and sleep-related quality of life. Design, Setting, and Participants:Patient-level data were pooled from 3 prospective cohorts and 1 retrospective observational cohort comprising 584 adults with moderate to severe obstructive sleep apnea unable to tolerate or benefit from continuous positive airway pressure. The data were gathered from the Stimulation Therapy for Apnea Reduction Trial; a postmarket approval study conducted in Germany; the multicenter, international Adherence and Outcome of Upper Airway Stimulation for OSA Registry; and a retrospective cohort study from 2 sites in the United States. Exposure:Hypoglossal nerve stimulation. Main Outcomes and Measures:Severity of obstructive sleep apnea was the primary outcome. The apnea-hypopnea index (AHI) (<5, normal; 5-15, mild; 15-30, moderate, and >30, severe) and Epworth Sleepiness Scale (range, 0-24; score >10 indicates pathologic sleepiness) outcomes were available at 2 to 6 months from 2 cohorts (n?=?398), at 12 months from 1 cohort (n?=?126), and at both times from 1 cohort (n?=?60). Sleep-related quality of life and oxygen saturation nadir data were collected where available. Linear mixed-effects models were constructed to examine associations between clinical variables and reported postoperative outcomes at 6 and 12 months with study included as a random effect. Results:Of the 584 patients included in the study, 472 were men (80.8%); mean (SD) age was 58.5 (11.0) years. Greater improvement in the postoperative AHI was associated with a higher preoperative AHI (-0.74 events/h; 95% CI, -0.82 to -0.67), older patient age (-0.10 events/h; 95% CI, -0.20 to -0.00), and lower body mass index (0.52; 95% CI, 0.22-0.83). After adjusting for these variables and considering all patients in the analysis, the AHI was statistically higher at 12 months than at 6 months (3.24 events/h; 95% CI, 1.67-4.82 events/h). Conclusions and Relevance:Hypoglossal nerve stimulation demonstrated clinically significant improvements in obstructive sleep apnea severity, daytime sleepiness, and sleep-related quality of life in this pooled cohort of patient-level results. Age, body mass index, and preoperative AHI appeared to be associated with treatment outcomes, and these variables may explain some of the difference between 2- to 6-month and 12-month outcomes.

Project description:ImportanceRecent retrospective hypoglossal nerve stimulation (HGNS) outcomes data suggest that patients with low therapeutic positive airway pressure (PAP) levels achieve greater success than patients with high therapeutic PAP levels.ObjectiveTo examine the use of therapeutic nasal PAP levels at the soft palate in predicting the outcomes of HGNS for patients with obstructive sleep apnea.Design, setting, and participantsThis prospective cohort study used drug-induced sleep endoscopy (DISE) to evaluate the predictive capacity of therapeutic PAP levels in HGNS outcomes. In an academic sleep surgery center, 27 consecutive patients with obstructive sleep apnea who underwent DISE before implantation of an HGNS device were evaluated. The study was conducted from May 1, 2018, to June 26, 2019.ExposuresPositive airway pressure delivered through a nasal mask during DISE.Main outcomes and measuresImprovement in apnea-hypopnea index as measured from full-night preoperative and postoperative efficacy studies.ResultsTwenty-seven patients met all inclusion criteria. The mean (SD) age was 62.0 (14.4) years, 14 participants were men (51.9%), and mean body mass index was 28.1 (4.0). Responders to HGNS therapy (n = 18) had significantly lower mean (SD) palatal opening pressure compared with nonresponders (n = 9) (5.0 [2.8] vs 9.2 [3.7] cm H2O, respectively; mean difference, -4.2; 95% CI, -6.8 to -1.6 cm H2O). After adjusting for age, sex, and body mass index, the mean palatal opening pressure value for the responders remained 3.5 cm H2O lower (95% CI, -6.7 to -0.4 cm H2O) than that of nonresponders. A palatal opening pressure cutoff level less than 8 cm H2O demonstrated a positive predictive value of 82.4%; sensitivity, 77.8%; and specificity, 66.7%.Conclusions and relevanceIn this small prospective cohort study, therapeutic nasal PAP levels during DISE differed significantly between responder and nonresponders to HGNS. Because DISE represents a mandatory, relatively standardized diagnostic tool for HGNS candidacy, the use of therapeutic nasal PAP through DISE can be broadly implemented and studied across multiple centers to possibly improve patient selection for HGNS.

Dataset Information

Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea.

Publications

Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea.

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