Baseline Characteristics Associated with Hypoglossal Nerve Stimulation Treatment Outcomes in Patients with Obstructive Sleep Apnea: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Search
2.2. Eligibility Criteria
2.3. Data Collection
2.4. Methodological Quality of Included Studies
3. Results
3.1. Search Results and Study Characteristics
3.2. Methodological Quality of Included Studies
3.3. Baseline Characteristics Associated with Treatment Response
3.3.1. Demographic Measurements
3.3.2. Clinical Measurements
3.3.3. Pathophysiological Measurements
3.3.4. Prior Upper Airway Surgery
4. Discussion
4.1. Baseline Characteristics
4.1.1. Demographic Measurements
4.1.2. Clinical Measurements
4.1.3. Pathophysiological Measurements
4.1.4. Other Measurements
4.2. Follow-Up
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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First Author | Year | Trial (If Applicable) | Design | Primary Outcome | Sample (R:NR) | Follow-Up Sleep Study (Months) | Baseline Characteristics | Responder Definition | Device | COI |
---|---|---|---|---|---|---|---|---|---|---|
Bosschieter [39] | 2022 | ADHERE | Retrospective analysis of prospective data | Change in AHI after 12 months of HGNS therapy for each group | 890 (593:297) | 12 | AHI (severity-groups) | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Coca [40] | 2022 | ADHERE | Retrospective analysis of prospective data | HGNS adherence in responders and non-responders | 717 (497:220) | 12 | Age, sex, BMI, AHI, ODI, ESS | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Gao [41] | 2023 | / | Retrospective case series | HGNS outcomes in apnea- and hypopnea-predominance | 56 | 12 | Apnea or hypopnea predominancy | ≥50% AHI reduction + AHI < 20/h | N/A | Yes |
Heiser [23] | 2019 | ADHERE | Retrospective analysis of prospective data | Predictors of responsiveness and adherence of therapy use | 227 | 12 | Age, sex, BMI, AHI | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Kant (a) [42] | 2024 | / | Retrospective | Change in AHI after 12 months of HGNS therapy for each group | 56 (C-AP); 10 (AP/CCC) | 12 | Site of collapse | ≥50% AHI reduction + AHI < 20/h | Inspire | No |
Kant (b) [43] | 2024 | / | Retrospective | Change in AHI during HGNS therapy for groups with and without floppy epiglottis | 75 (53:22) | 12 | Site of collapse | ≥50% AHI reduction + AHI < 20/h | Inspire | No |
Kent [44] | 2019 | STAR, GPMS, ADHERE, US cohort study | Prospective and retrospective | OSA severity at baseline associated with postoperative HGNS outcomes | 584 (450:134) | 12 | Age, sex, BMI, AHI, neck circumference | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Kezirian [45] | 2014 | / | Prospective | Change in AHI after 12 months of HGNS therapy | 31 (17:14) | 12 | BMI | ≥50% AHI reduction + AHI < 20/h | Apnex | Yes |
Kezirian [46] | 2019 | ADHERE | Retrospective analysis of prospective data | % responders at final visit for groups with prior upper airway surgery | 147 (116:31) | 12 | Prior upper airway surgery | ≥50% AHI reduction + AHI <20/h | Inspire | Yes |
Lee [38] | 2019 | / | Pro- and retrospective | Change in AHI during HGNS therapy for low and high PAP group | 56 (31:25) | >6 | Therapeutic PAP level | ≥50% AHI reduction + AHI < 20/h (+ analyses on AHI < 10/h and < 5/h) | Inspire | No |
Lee [47] | 2021 | / | Prospective and retrospective | Radiographic predictors of HGNS response during cephalometry | 51 (24:27) | 3–12 | Age, BMI, AHI | ≥50% AHI reduction + AHI < 20/h | Inspire | No |
Mulholland [48] | 2020 | / | Prospective | Change in palate and oropharynx during mandibular advancement | 46 | N/A | Site of collapse | N/A | Inspire | No |
Ong [49] | 2016 | STAR | Retrospective analysis of prospective data | Collapse patterns during baseline DISE predictive of HGNS response | 124(84:40) | 12 | Age, sex, BMI, AHI, site of collapse, neck size | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Op de Beeck [37] | 2021 | STAR | Retrospective analysis of prospective data | Pathophysiological mechanisms underlying favorable versus incomplete responses to HGNS therapy | 91 (53:38) | 12 | Age, sex, BMI, AHI, ODI, arousal threshold, collapsibility, muscle responsiveness, loop gain, SASHB | ≥50% AHI reduction + AHI < 10/h (+ sensitivity analyses on other definitions) | Inspire | Yes |
Renslo [50] | 2023 | / | Retrospective | Maneuvers during DISE predictive of HGNS outcome | 171 (61:110) | N/A | Age, gender, AHI, oxygen nadir, site of collapse | ≥50% AHI reduction + AHI < 15/h | N/A | No |
Schwab [51] | 2018 | / | Prospective | Anatomic predictors (site of collapse) of HGNS response | 13 (7:6) | 12 | Age, BMI, AHI | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Seay [52] | 2020 | / | Prospective | Therapeutic nasal PAP levels at the soft palate during DISE, predictive of HGNS response | 27 (18:9) | >3 | Age, sex, BMI, AHI, site of collapse | ≥50% AHI reduction | Inspire | No |
Steffen [21] | 2018 | GPMS | Prospective | Change in AHI, ESS and FOSQ after 12 months of HGNS therapy | 56 (41:15) | 12 | Age, BMI, AHI, ODI, ESS, neck circumference, prior upper airway surgery | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Suurna [53] | 2021 | ADHERE | Retrospective analysis of prospective data | Change in AHI and ESS after 12 months of HGNS therapy, specifically in BMI ≤ 32 and between 32 and 35 | 535 | 12 | BMI | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Thaler [22] | 2020 | ADHERE | Retrospective analysis of prospective data | Change in AHI after 12 months of HGNS therapy and predictors | 382 (265:117) | 12 | Age, sex, BMI, AHI | ≥50% AHI reduction + AHI <20/h (+ sensitivity analyses on ≥50% AHI reduction + AHI < 10/h, and AHI < 10) | Inspire | Yes |
Vanderveken [20] | 2013 | / | Prospective | Collapse patterns during baseline DISE predictive of HGNS response | 21 (13:8) | 6 | Site of collapse | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Van de Heyning [54] | 2012 | / | Prospective | Change in AHI and ODI after 6 months of HGNS therapy | 20 (6:14) | 6 | AHI, BMI, ESS | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Wang [55] | 2022 | / | Retrospective | Data from intra-operative tongue muscle activation associated with post-operative HGNS response | 46 (28:18) | 6-12 | Age, sex, BMI | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
Wirth [56] | 2022 | / | Prospective | Manometric sites of collapse predictive of HGNS response | 26 (11:15) | 3-12 | AHI | ≥50% AHI reduction + AHI < 15/h | N/A | Yes |
Withrow [57] | 2019 | ADHERE | Retrospective analysis of prospective data | Change in AHI during HGNS therapy for old and young group | 250 | 12 | Age | N/A | Inspire | Yes |
Yu [58] | 2021 | STAR | Retrospective analysis of prospective data | Change in AHI after 12 months of HGNS therapy | 105 (72:33) | 12 | Age, sex, BMI, AHI, ESS, neck circumference | ≥50% AHI reduction + AHI < 20/h | Inspire | Yes |
First Author | Quality Assessment of Included Studies | |||||||
---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
Bosschieter 2022 [39] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Coca 2022 [40] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Gao 2023 [41] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Heiser 2019 [23] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Kant (a) 2024 [42] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Kant (b) 2024 [43] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Kent 2019 [44] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Kezirian 2014 [45] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Kezirian 2019 [46] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Lee 2019 [38] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
Lee 2021 [47] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Mulholland 2020 [48] | No | Yes | Yes | Yes | Yes | No | Yes | Yes |
Ong 2016 [49] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Op de Beeck 2021 [37] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Renslo 2023 [50] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Schwab 2018 [51] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Seay 2020 [52] | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Steffen 2018 [21] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Suurna 2021 [53] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Thaler 2020 [22] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Vanderveken 2013 [20] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Van de Heyning 2012 [54] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Wang 2022 [55] | No | Yes | Yes | Yes | No | No | Yes | Yes |
Wirth 2022 [56] | No | Yes | Yes | Yes | Yes | No | Yes | Yes |
Withrow 2019 [57] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Yu 2021 [58] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes |
Baseline Characteristic | Association | # of Studies | References |
---|---|---|---|
Demographic | |||
Age | Older age was associated with AHI reduction or treatment response | 1 | [23] |
Older patients (≥65 years) had a larger AHI reduction than younger patients (<65 years) | 1 | [57] | |
No association between age and treatment outcome | 1 | [22] | |
Older age was associated with AHI reduction or treatment response | 2 | [44,49] | |
No association between age and treatment outcome | 9 | [21,37,40,47,50,51,52,55,58] | |
Sex | Female sex was associated with AHI reduction or treatment response | 1 | [22] |
No association between sex and treatment outcome | 1 | [23] | |
No association between sex and treatment outcome | 6 | [37,40,44,49,55,58] | |
Female sex was associated with AHI reduction or treatment response | 1 | [52] | |
Male gender was associated with AHI reduction in univariable analysis, but not in multivariable analysis | 1 | [50] | |
BMI | Lower baseline BMI was associated with increased AHI reduction or treatment response | 2 | [22,23] |
No difference in AHI reduction between groups with BMI ≤ 32 kg/m2 and 32 < BMI ≤ 35 kg/m2 | 1 | [53] | |
No association between baseline BMI and treatment outcome | 6 | [21,47,49,51,52,58] | |
Lower baseline BMI was associated with increased AHI reduction or treatment response | 6 | [37,40,44,50,54,55] | |
Non-significant AHI reduction in group with BMI > 35 kg/m2, but significant AHI reduction in group with BMI ≤ 35 kg/m2 | 1 | [45] | |
Clinical | |||
AHI | No association between baseline AHI and treatment outcome | 3 | [22,23,39] |
No association between baseline AHI and treatment outcome | 9 | [21,37,40,47,49,51,52,56,58] | |
Higher baseline AHI was associated with increased AHI reduction or treatment response | 2 | [44,50] | |
Lower baseline AHI was associated with increased treatment response | 1 | [54] | |
ODI | No association between baseline ODI and treatment outcome | 2 | [37,40] |
Lower baseline ODI was associated with treatment response | 1 | [21] | |
ESS | No association between ESS and treatment response | 5 | [21,40,52,54,58] |
Neck circumference | No association between neck circumference and treatment response | 4 | [21,44,49,58] |
Apnea- or hypopnea-dependent | No association between apnea or hypopnea dependency (meaning either apnea or hypopnea predominancy) and treatment response | 1 | [41] |
Oxygen nadir | Oxygen nadir was associated with AHI reduction in multivariable analysis, but not in univariable analysis | 1 | [50] |
Pathophysiological | |||
Site of collapse | No association between degree of oropharyngeal or tongue base collapse, and treatment response | 1 * | [49] |
No association between presence of a floppy epiglottis and treatment response | 1 | [43] | |
Absence of complete concentric collapse at the palate was associated with increased treatment response | 1 | [20] | |
Complete collapse at the palate and lateral walls was associated with poorer response compared to patients who had partial collapse at the palate and lateral walls | 1 ** | [48] | |
No association between either palatal or tongue base response during jaw thrust or chin lift and change in AHI | 1 | [50] | |
Lower proportion of antero-posterior or latero-lateral collapse at the palate was associated with increased treatment response | 1 * | [49] | |
Lower proportion of antero-posterior or latero-lateral collapse at the epiglottis was associated with increased treatment response | 1 * | [49] | |
A decreased oropharyngeal response during mandibular advancement was associated with increased AHI reduction during HGNS | 1 ** | [48] | |
A decreased palato-oropharyngeal response during mandibular advancement was associated with increased AHI reduction during HGNS | 1 ** | [48] | |
No association between degree of palatal collapse and treatment response | 1 | [52] | |
Higher baseline VOTE-score was associated with increased treatment response | 1* | [49] | |
Endotypes (arousal threshold, muscle responsiveness, loop gain, collapsibility) | Higher arousal threshold was associated with treatment response. Higher muscle responsiveness was associated with treatment response, especially in patients with mild collapsibility. Lower loop gain was associated with treatment response, particularly in patients with milder upper airway collapsibility. Lower collapsibility was associated with treatment failure, specifically in patients with high loop gain and low arousal threshold. | 1 | [37] |
Therapeutic PAP level | Low baseline PAP (<8 cm H2O) was associated with AHI reduction and treatment response | 1 | [38] |
SASHB | No association between baseline SASHB and treatment response | 1 | [37] |
Other | |||
Prior upper airway surgery | No association between prior upper airway surgery and treatment outcome | 1 | [46] |
No association between prior upper airway surgery and treatment outcome | 1 | [21] |
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Tukanov, E.; Van Loo, D.; Dieltjens, M.; Verbraecken, J.; Vanderveken, O.M.; Op de Beeck, S. Baseline Characteristics Associated with Hypoglossal Nerve Stimulation Treatment Outcomes in Patients with Obstructive Sleep Apnea: A Systematic Review. Life 2024, 14, 1129. https://doi.org/10.3390/life14091129
Tukanov E, Van Loo D, Dieltjens M, Verbraecken J, Vanderveken OM, Op de Beeck S. Baseline Characteristics Associated with Hypoglossal Nerve Stimulation Treatment Outcomes in Patients with Obstructive Sleep Apnea: A Systematic Review. Life. 2024; 14(9):1129. https://doi.org/10.3390/life14091129
Chicago/Turabian StyleTukanov, Eldar, Dorine Van Loo, Marijke Dieltjens, Johan Verbraecken, Olivier M. Vanderveken, and Sara Op de Beeck. 2024. "Baseline Characteristics Associated with Hypoglossal Nerve Stimulation Treatment Outcomes in Patients with Obstructive Sleep Apnea: A Systematic Review" Life 14, no. 9: 1129. https://doi.org/10.3390/life14091129