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Evaluation of body position in upper airway stimulation for obstructive sleep apnea—is continuous voltage sufficient enough?

  • ENT • Original Article
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Abstract

Purpose

The definition of positional obstructive sleep apnea (POSA) is widely accepted as a difference of 50% or more in AHI between supine and non-supine position. Upper airway stimulation (UAS) is an effective treatment for OSA but the implant delivers a single voltage over sleep period without consideration of body position. Clinical practice suggests different outcomes for OSA in supine position under UAS treatment.

Methods

Outcomes of 44 patients were analyzed 12 months after implantation in a two-center, prospective consecutive trial in a university hospital setting. Total night and supine AHI were evaluated and the ratio of time spent in supine was considered. Correlation between the classic and the modified definition of POSA and treatment response were evaluated.

Results

The time ratio spent in supine position did not differ before implantation and after 12 months. Total and supine AHI were reduced with the use of UAS therapy (p < 0.001) but both the baseline and final supine AHI were higher than total night AHI. Considering POSA definition as a ratio of supine to non-supine AHI, there was no clear cutoff for defining responders neither with nor without the additional component of time in supine position.

Conclusions

The OSA reduction is strong for the total AHI and supine AHI. Nonetheless, here, there is no cutoff for defining POSA as critical for UAS therapy response. Therefore, there is no evidence for excluding POSA patients from UAS in general. Future technology improvement should take body position and adaptive voltage into account.

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Acknowledgements

We wish to express our gratitude to Quan Ni, PhD, and Luke Lozier, Inspire Medical, for the consultative input on this study.

Funding

There was no external funding for this evaluation. Underlying data from German Post-market Study was furnished by Inspire Medical Systems, Inc.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Armin Steffen & Julia T. Hartmann

  2. Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Inke R. König

  3. Department of Otorhinolaryngology, OLVG, Amsterdam, The Netherlands

    Madeline J. L. Ravesloot

  4. Department of Otorhinolaryngology, Medisch Centrum Jan van Goyen, Amsterdam, the Netherlands

    Madeline J. L. Ravesloot

  5. Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany

    Benedikt Hofauer & Clemens Heiser

Authors
  1. Armin Steffen
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  2. Julia T. Hartmann
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  3. Inke R. König
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  4. Madeline J. L. Ravesloot
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  5. Benedikt Hofauer
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  6. Clemens Heiser
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Corresponding author

Correspondence to Armin Steffen.

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Conflict of interest

Armin Steffen and Clemens Heiser are study investigators and received honoraria and travel expenses for invited talks on behalf of Inspire Medical, Inc., outside the submitted work. Benedikt Hofauer received travel expenses from Inspire Medical, Inc. Inke R. König and Julia Hartmann have nothing to declare. Madeline Ravesloot is a consultant for Nightbalance.

Informed consent

Informed consent was obtained for each patient. The study was approved by the local ethics committee (Ethikkommission, Universität zu Lübeck, Germany; Fakultät für Medizin, Ethikkommission, Technische Universität München, Germany) and is a sub-investigation of the German Post-market Study registered as NCT02293746 on clinicaltrials.gov.

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Steffen, A., Hartmann, J.T., König, I.R. et al. Evaluation of body position in upper airway stimulation for obstructive sleep apnea—is continuous voltage sufficient enough?. Sleep Breath 22, 1207–1212 (2018). https://doi.org/10.1007/s11325-018-1716-5

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  • DOI: https://doi.org/10.1007/s11325-018-1716-5

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