Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation

STUDY OBJECTIVES

To determine whether home sleep apnea testing with peripheral arterial tonometry (HSAT-PAT) can be used in upper airway stimulation to evaluate therapy success.

METHODS

Data analysis from 50 consecutive patients receiving upper airway stimulation was performed. Baseline values were measured by polysomnography and HSAT-PAT. Follow-up was performed during and after titration (3-6 months) by polysomnography and HSAT-PAT and after 1 year by HSAT-PAT only. Primary outcome measures were reduction in the apnea-hypopnea index and oxygen desaturation index. In addition, an analysis of night-to-night variability for HSAT-PAT was performed.

RESULTS

All 50 patients completed their posttitration visit (3-6 months) and 41 patients completed the 1-year follow-up. In HSAT-PAT after 1 year, the mean apnea-hypopnea index (desaturation 3%) was reduced from 29.5 ± 17.1 events/h to 19.9 ± 13.1 events/h (P < .01) and the oxygen desaturation index (desaturation 4%) was reduced from 17.8 ± 12.6 events/h to 10.2 ± 8.3 events/h (P < .01). Therapy adherence after 1 year was high (6.6 ± 1.9 hours per night) and led to improvement in daytime sleepiness, meaning a reduction in the Epworth Sleepiness Scale score from 12.8 ± 5.4 to 5.9 ± 4.0 (P < .01). Analysis of night-to-night variability showed similar apnea-hypopnea index values between the 2 nights.

CONCLUSIONS

Upper airway stimulation was able to reduce the apnea-hypopnea index and oxygen desaturation index after 1 year, as assessed by full-night efficacy studies with HSAT-PAT. In addition, improvements in self-reported outcome parameters were observed. The importance of publishing the scoring criteria is highlighted and whether data are based on full-night efficacy studies or a selected period of time from a sleep study. This is a prerequisite for comparing data with other trials in the emerging field of upper airway stimulation.

CITATION

Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med. 2022;18(9):2197-2205.

[Diagnosis and Treatment of Obstructive Sleep Apnea Syndrome]

Sleep-related breathing disorders range from habitual snoring to severe obstructive sleep apnea syndrome. The prevalence of habitual snoring is high and up to 60 % depending on age, sex and body weight. However, in contrast to habitual snoring obstructive sleep apnea syndrome may be associated with medical complications. The prevalence of obstructive sleep apnea is 2 – 5 % of the adult population. The article presents an overview of the diagnostic and therapeutic options. Continous positiv pressure therapy (CPAP) is the standard treatment for obstructive sleep apnea. However, long-term compliance of CPAP therapy is limited. Alternative therapeutic possibilities are presented and discussed.

Neuroradiologische Diagnostik bei Patienten mit sensorineuralem Hörverlust vor Cochlea-Implantation

Cochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiological assessment is essential for correctly evaluating the indication for surgery and safely performing cochlear implantation. CT and conventional and functional MRI are available for radiological assessment. Therefore, knowledge of the most frequent congenital syndromal, non-syndromal, and acquired malformations of inner ear structures is fundamental. This article provides information about imaging techniques prior to CI and relevant malformations of the inner ear. Safety aspects for patients with a cochlear implant undergoing MR imaging are also discussed.

[Long term results after cochlear implantation in elderly patients]

BACKGROUND

Cochlear implantation has become the method of choice for the treatment of deaf patients. A better technology of stimulation opened a wider field of patients suitable for cochlear implantation. Aim of the present study was to evaluate to which extent senior patients benefit by cochlear implantation.

PATIENTS AND METHODS

36 patients between 65 and 85 years were tested by the Freiburger speech test for monosyllabic words and by the HSM sentence test with and without noise. The results were compared to those of younger implanted patients (16 - 64 years, n = 101).

RESULTS

The speech perception for monosyllabic words did not differ significantly between both groups. A maximum plateau in speech perception for monosyllabic words was reached after 2 years at 55 %. The HSM sentence test revealed significant differences in the increase of speech perception between senior and younger patients in the first post surgical year. After one year elderly patients reached the same perception score as younger patients with a maximum of approximately 80 % after 3 years. At a signal to noise ratio of 15 % younger patients achieved a maximal perception of 55 % after 1 year whereas senior patients needed 4 years to reach this level.

CONCLUSIONS

Senior patients benefited by cochlear implantation to the same extent as younger patients did. Senior patients gained a similar speech perception level as younger implanted patients although the elderly needed more time to reach the same scores. Nevertheless, cochlear implantation should not be denied due to age alone.

Predicting the potential for risky behavior among those "too young" to drink as the result of appealing advertising

A survey of 273 children in Washington state used a predrinking behavior index as a behavioral outcome to assess media effects on precursors to drinking among children for whom alcohol consumption is not yet occurring. It also examined age trends in relevant beliefs and behaviors. Perceptions of advertising desirability, the extent to which it seemed appealing, increased steadily from third to ninth grade, whereas identification with portrayals, the degree to which individuals wanted to emulate portrayals, leveled off after sixth grade. Expectancies, positive social benefits perceived to be associated with drinking alcohol, also increased with age, particularly between sixth and ninth grade. When demographics and grade level were controlled, desirability predicted identification, and both predicted expectancies, which is consistent with media decision-making theory. Expectancies correlated with alcohol predrinking behavior, and expectancies predicted risky behavior, with demographics and grade level controlled. Predrinking behavior and reported risky behavior were correlated. The results provide cross-sectional support for the view that beliefs and desires developing by third grade prime children for future decisions regarding substance use.

Noninvasive direct stimulation of the cochlear nerve for functional MR imaging of the auditory cortex

We herein present our preliminary experience with functional MR imaging of the direct electrical stimulation of the cochlear nerve using an MR imaging-compatible electrode placed in the external auditory meatus of five patients with binaural sensorineural hearing loss. The stimulator was placed outside the imager's bore, and the electrode produced virtually no susceptibility artifacts. In three of five patients, it was possible to activate the superior temporal gyrus during functional MR imaging. No side effects were observed.