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      Upper Airway Stimulation in the Management of Obstructive Sleep Apnea Syndrome: Neurostimulation of Hypoglossal Nerve

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          A bstract

          Obstructive sleep apnea (OSA) syndrome is one of the most prevalent chronic diseases in the general population. Continuous positive airway pressure (CPAP), is considered the gold standard therapy for its treatment, but adherence is a critical issue that decreases its use. Upper airway stimulation (UAS) through selective hypoglossal nerve stimulation has emerged as a non-anatomically modifying surgery has shown long-term improvements in objective respiratory and subjective quality-of-life outcome measures. It provides multilevel upper airway improvement through its action at the retrolingual and retropalatal portion of the airway, with the advantage of being an adjustable medical device. The two different commercially available implants are Imthera (LivaNova) and Inspire (Inspire Medical Systems). A large amount of information has been described mainly with the Inspire upper airway stimulation system. Patient selection criteria, implantation timeline, the operative procedure with activation and follow-up are discussed. Multiple studies that have shown significant improvements in both subjective and objective outcome measures as apnea hypopnea index (AHI), oxygen desaturation index (ODI), Epworth sleepiness scale (ESS), functional outcomes of sleep questionnaire (FOSQ) have been shown to be maintained respectively at long term follow-up.

          How to cite this article: Baptista P, Prieto C, Garaycochea O. Upper Airway Stimulation in the Management of Obstructive Sleep Apnea Syndrome: Neurostimulation of Hypoglossal Nerve. Int J Head Neck Surg 2019;10(4):77–85.

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          Most cited references41

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          The epidemiology of adult obstructive sleep apnea.

          Obstructive sleep apnea is a chronic condition characterized by frequent episodes of upper airway collapse during sleep. Its effect on nocturnal sleep quality and ensuing daytime fatigue and sleepiness are widely acknowledged. Increasingly, obstructive sleep apnea is also being recognized as an independent risk factor for several clinical consequences, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. Estimates of disease prevalence are in the range of 3% to 7%, with certain subgroups of the population bearing higher risk. Factors that increase vulnerability for the disorder include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use. Despite the numerous advancements in our understanding of the pathogenesis and clinical consequences of the disorder, a majority of those affected remain undiagnosed. Simple queries of the patient or bed-partner for the symptoms and signs of the disorder, namely, loud snoring, observed apneas, and daytime sleepiness, would help identify those in need of further diagnostic evaluation. The primary objective of this article is to review some of the epidemiologic aspects of obstructive sleep apnea in adults.
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            Trends in CPAP adherence over twenty years of data collection: a flattened curve

            Background Obstructive sleep apnea (OSA) is a common disorder, and continuous airway positive pressure (CPAP) is considered to be the gold standard of therapy. CPAP however is known to have problems with adherence, with many patients eventually abandoning the device. The purpose of this paper is to assess secular trends in CPAP adherence over the long term to see if there have been meaningful improvements in adherence in light of the multiple interventions proposed to do so. Methods A comprehensive systematic literature review was conducted using the Medline-Ovid, Embase, and Pubmed databases, searching for data regarding CPAP adherence over a twenty year timeframe (1994–2015). Data was assessed for quality and then extracted. The main outcome measure was reported CPAP non-adherence. Secondary outcomes included changes in CPAP non-adherence when comparing short versus long-term, and changes in terms of behavioral counseling. Results Eighty-two papers met study inclusion/exclusion criteria. The overall CPAP non-adherence rate based on a 7-h/night sleep time that was reported in studies conducted over the twenty year time frame was 34.1 %. There was no significant improvement over the time frame. Behavioral intervention improved adherence rates by ~1 h per night on average. Conclusions The rate of CPAP adherence remains persistently low over twenty years worth of reported data. No clinically significant improvement in CPAP adherence was seen even in recent years despite efforts toward behavioral intervention and patient coaching. This low rate of adherence is problematic, and calls into question the concept of CPAP as gold-standard of therapy for OSA.
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              Adherence to continuous positive airway pressure therapy: the challenge to effective treatment.

              Despite the high efficacy of continuous positive airway pressure (CPAP) to reverse upper airway obstruction in sleep apnea, treatment effectiveness is limited by variable adherence to prescribed therapy. When adherence is defined as greater than 4 hours of nightly use, 46 to 83% of patients with obstructive sleep apnea have been reported to be nonadherent to treatment. Evidence suggests that use of CPAP for longer than 6 hours decreases sleepiness, improves daily functioning, and restores memory to normal levels. The decision to embrace CPAP occurs during the first few days of treatment. Although many strategies in patient interface with CPAP or machine modality are marketed to improve CPAP usage, there are few data to support this. No single factor has been consistently identified as predictive of adherence. Patient perception of symptoms and improvement in sleepiness and daily functioning may be more important in determining patterns of use than physiologic aspects of disease severity. Emerging data suggest that various behavioral interventions may be effective in improving CPAP adherence.
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                Author and article information

                Journal
                IJHNS
                International Journal of Head and Neck Surgery
                IJHNS
                Jaypee Brothers Medical Publishers
                0975-7899
                0976-0539
                October-December 2019
                : 10
                : 4
                : 77-85
                Affiliations
                [1–3 ]Department of Otorhinolaryngology, Clínica Universidad Navarra, Pamplona, Navarra, Spain
                Author notes
                Peter Baptista, Department of Otorhinolaryngology, Clínica Universidad Navarra, Pamplona, Navarra, Spain, Phone: +34637126088, e-mail: pmbaptista@ 123456unav.es
                Article
                10.5005/jp-journals-10001-1381
                8780d7c8-4313-4d34-8a6e-805af3a09af7
                Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.

                © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Categories
                SPECIAL ISSUE 4: INVITED ARTICLE
                Custom metadata
                ijhns-2019-10-77.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Functional outcomes of sleep questionnaire,Upper airway stimulation,Continuous positive airway pressure

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