Efficient sleep endoscopy planning prior to breathing-dependent unilateral hypoglossal nerve stimulation
Dr. Arne Böttcher
Born in 1980 in Güstrow, he is Senior Physician and Section Lead of Head and Neck Surgery at the University Medical Center Hamburg-Eppendorf. Specialist in ENT, Allergology, and Plastic Surgery, currently trained in Sleep Medicine.
Fast-track DISE prior to Upper Airway Stimulation
Introduction
The implantation of breathing-dependent unilateral hypoglossal nerve stimulation (HNS) has traditionally required the preoperative exclusion of complete concentric velopharyngeal collapse (CCC) through drug-induced sleep endoscopy (DISE). This prerequisite poses logistical and operational challenges for implantation teams. To address these issues, the Eppendorf DISE-concept was developed to streamline the process, making it more patient-friendly, cost-effective, and time-efficient.
Material and methods
We retrospectively examined HNS patients who were preoperatively examined for CCC using the Müller’s maneuver and simulated snoring in a supine position using transnasal flexible endoscopy. If the findings were unremarkable, with no evidence of CCC, the DISE was performed directly before the implantation in the same procedure.
Results
We examined 28 patients, of whom 7.9% presented remarkable findings during the Müller manoeuvre or simulated snoring. These patients also showed a CCC during DISE. If the Müller’s maneuver was unremarkable, no CCC was observed in DISE either, resulting in 100% sensitivity, specificity, positive and negative predictive values. Thus, there is a significant direct relationship between Müller’s maneuver results and velopharyngeal findings during DISE as confirmed by Fisher’s exact test(p = 0.0026, p < 0.05).
Conclusion
The Eppendorf DISE-concept has been shown to be a reliable method for predicting a low likelihood of CCC in a patient-oriented, cost-effective and time-efficient manner. It is yet to be determined how long the CCC will remain as an exclusion criterion for breathing-dependent unilateral HNS implantation.
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