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BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Objective: Hypoglossal nerve stimulation (HGNS) is an implantable therapy for obstructive sleep apnea (OSA). Therapy efficacy is currently confirmed by a formal sleep study after empiric adjustment by the patient at home based on their subjective experience with the device. Home‐based longitudinal apnea hypopnea index (AHI) measurements have the potential to refine HGNS therapeutic amplitude selection with objective data. Our objective was to compare AHI derived from routine sleep studies and two different home sleep devices in new HGNS recipients. Methods: Prospectively enrolled patients receiving HGNS therapy were provided a Sleep Tracking Mat (Withings, Issy‐les‐Moulineaux, France) and NightOwl peripheral arterial tonometry (PAT) sensor (Ectosense, Leuven, Belgium) for longitudinal, home AHI monitoring from 1 to 6 months post‐implant. Therapy efficacy was assessed at 3 and 6 months post‐implant using in‐lab polysomnography (PSG) or home sleep apnea test (HSAT). The sleep mat and PAT sensor AHI were compared against PSG and HSAT for accuracy of OSA severity identification. Results: Sixty patients were enrolled across 5 centers and followed for 6 months. The sleep mat had sensitivity and specificity for identifying AHI <15 of 61% and 82% and AHI <30 of 77% and 100%. The PAT device had sensitivity and specificity for identifying AHI <15 of 57% and 77% and AHI <30 of 81% and 80%. Conclusions: The sleep mat and PAT sensor demonstrated high sensitivity and specificity for detection of mild and moderate OSA in patients with HGNS therapy and may enable longitudinal objective monitoring of HGNS efficacy in the home setting. Level of Evidence: 3 Laryngoscope, 135:469–477, 2025 [ABSTRACT FROM AUTHOR]

Objective: The efficacy of hypoglossal nerve stimulation (HGNS) therapy is limited by obstruction of the oropharyngeal lateral walls (OLWs). Our objective was to investigate the effect of palatine tonsillectomy on HGNS efficacy in obstructive sleep apnea (OSA) patients with OLW collapse. Study Design: Case‐control study of patients with moderate‐to‐severe OSA, complete‐or‐partial OLW collapse, and small tonsils (1 − 2+). Concomitant palatine tonsillectomy and HGNS (HGNS+T) were compared against a control group of patients who underwent HGNS alone. Setting: Single academic institution. Methods: Study outcomes were measures of HGNS efficacy defined as a %reduction in apnea‐hypopnea index (AHI) (primary) and successful treatment response (50% AHI reduction to <15/h, logistic regression), respectively. Regression analyses quantified the additional effect of tonsillectomy (HGNS+T vs HGNS alone, independent variable) on HGNS efficacy. Analyses were adjusted for OLW collapse severity (complete vs partial), tonsil size, age, sex, body mass index, and baseline AHI. Results: Nineteen patients underwent HGNS+T and had follow‐up sleep testing for the current analysis. The control group (HGNS alone) consisted of 78 patients. Baseline demographics and OSA severity were similar between the groups, except HGNS+T group had increased prevalence of complete OLW collapse. Linear regression demonstrated that adding tonsillectomy resulted in an additional 22.9% [7.5, 35.2] reduction in AHI [95% confidence interval, CI] (P =.006), and 8.6 [1.7,43.4] (P =.010) greater odds [95% CI] of a successful treatment response with HGNS. Conclusion: Compared to historically poorer outcomes of HGNS in patients with OLW collapse, these early results suggest combining tonsillectomy with HGNS may represent a promising strategy to improve success rates. [ABSTRACT FROM AUTHOR]

Objective: The aim was to determine the potential association between palate shape and unilateral hypoglossal nerve stimulation (HNS) outcomes. Methods: Preoperative drug‐induced sleep endoscopy (DISE) videos were reviewed and scored by 3 blinded reviewers to determine airway narrowing at the hard‐soft palate junction (HP), soft palate genu, and inferior velum, as described by Woodson (2014). Scoring was as follows: 1–open airway, 2–narrow, 3–severe narrowing. Overall palate shape (oblique, intermediate, or vertical) was determined based on prior criteria. Successful surgical treatment was defined by the HNS titration polysomnogram as a reduction of ≥50% in the apnea‐hypopnea index (AHI) to <15 events/h. Results: Of 332 adults, the majority was male (77%) with an average BMI of 29.2 ± 3.6 kg/m2. Overall success rate was 73%. Success rate was lower in patients with vertical palate shape compared with the other shapes (56% vs. 75%, p = 0.029). HP score 3 compared with scores 2 and 1 was associated with lower success rates (60% vs. 76%, p = 0.028), but genu and velum scores were not associated with outcomes. Patients with both HP score 3 and complete oropharyngeal lateral wall‐related obstruction had notably worse outcomes (22% vs. 74%, p = 0.026). HP score 3 (OR 0.45, 95%CI 0.22–0.92) and vertical palate shape (OR 0.33, 95%CI 0.15–0.78) were independently associated with lower odds of surgical response after adjustment for DISE findings, age, gender, and BMI. Conclusion: Vertical palate shape and narrowing at the hard‐soft palate junction are independently associated with lower HNS surgical success rates. Level of Evidence: 3 Laryngoscope, 134:981–986, 2024 [ABSTRACT FROM AUTHOR]

Objective: To examine the changes in measures of sleep apnea severity and hypoxemia on the first postoperative night following implantation of the hypoglossal nerve stimulator. Study Design: This was a single-arm prospective cohort study. Setting: A single academic sleep surgical practice. Methods: Subjects with moderate to severe obstructive sleep apnea underwent implantation of the hypoglossal nerve stimulator (HGNS) and were discharged to home the same day as surgery. A single-night WatchPAT study was performed on the night immediately following surgery (PON 1) and was compared to baseline sleep testing. Results: Twenty subjects who were an average of 58.6 ± 2.5 years old, were 25% female, and had a mean body mass index of 28.1 ± 0.9 kg/m2 completed the study. Mean O2 nadir at baseline was 79.6% ± 1.1% compared to 82.7% ± 0.9% (P =.013) on PON 1. One patient demonstrated a >10% worsening in O2 nadir. Only 2 additional patients demonstrated a worsening in O2 nadir on PON 1, each by only 1 percentage point. Neither mean time spent below SpO2 88% nor oxygen desaturation index (ODI) worsened postoperatively (mean time spent below oxygen saturation of 88%, 27.8 ± 7.85 vs 11.2 ± 5.2, P =.03; mean ODI, 29.6 ± 5.2/h vs 21.0 ± 5.4/h, P =.10). Mean obstructive apnea hypopnea index (AHI) was no worse (40.6 ± 4.7/h to 28.7 ± 4.2/h, P =.02), with only 2 patients experiencing an obstructive AHI >20% more severe than baseline. Only 1 patient demonstrated a clinically meaningful increase in central AHI on PON 1. Conclusions: Overall, AHI and measures of nocturnal hypoxemia are stable, if not improved, on PON 1 following HGNS implantation. These findings support the safety of same-day discharge following implantation of the hypoglossal nerve stimulator. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of sleep disorders in the United States and the association between sleep disorders and all-cause mortality.Methods: A cross-sectional analysis of the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index (NDI) was performed. The 2009 to 2010 NHANES national household survey for adults ≥ 18 years was examined for the prevalence of sleep disorders as well as standard demographics and the presence of comorbidities (coronary artery disease [CAD], stroke, and emphysema). This dataset was linked to the 2015 NDI to associate the presence of sleep disorders with 5-year all-cause mortality.Results: The study sample had a mean age of 46.1 years old, was 48.3% male, and had an average body mass index (BMI) of 28.7 (28.4-28.9). 7.1% (6.5%-7.7%) of adults reported being diagnosed with a sleep disorder, which represents an estimated 15.9 million (13.2-18.6) patients. The estimated mortality rate for those having a sleep disorder was 9.3% (7.2%-11.9%) compared to 5.2% (4.5%-5.9%) without a sleep disorder (odds ratio 1.89, P = <.001). After adjusting for age, sex, BMI, CAD, stroke, and emphysema, having a sleep disorder remained a significant predictor of increased mortality (hazard ratio, 1.5 [1.02-2.18], P = .042).Conclusion: This study reports a high prevalence of self-reported but physician-diagnosed sleep disorders; however, this likely represents an underestimate. Given the association with all-cause mortality, there is a need for increased recognition of undiagnosed sleep disorders within the United States.Level Of Evidence: 2b Laryngoscope, 131:686-689, 2021. [ABSTRACT FROM AUTHOR]