Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?
Purpose Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence. Metho...
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| Veröffentlicht in: | Sleep & breathing 2025-03, Vol.29 (1), p.6, Article 6 |
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| creator | Alapati, Rahul Wang, Naomi Feucht, Maria Ramesh, Uma Bon Nieves, Antonio Arambula, Alexandra Renslo, Bryan Lawrence, Amelia Wagoner, Sarah F. Rouse, David Larsen, Christopher |
| description | Purpose
Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Methods
Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2–6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
Results
327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (
β
= 3.7, CI [1.3, 7.4], p = 0.038) and increased age (
β
= 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
Conclusions
UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted. |
| doi_str_mv | 10.1007/s11325-024-03174-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3132612854</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3132612854</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-1979e96cc12f9edb9e8ce30acd6b7920878be8f0cbb5d5ff1cb612ad556b7abf3</originalsourceid><addsrcrecordid>eNp9kL1OwzAURi0EolB4AQZkiYUl4OvETcyCEP9SJRY6W45zDanSONgJqG-PaQtIDEy2dM_3-foQcgTsDBjLzwNAykXCeJawFPIs4VtkDwTnCeRMbq_uLJEC-IjshzBnDLJCwi4ZpVIUIgO5R9Sso-_owxBo5T7aC3rjMFAzWEtDV7dIna-x7XVfu5Zqa9H0FLVvllRXr-ixNUh7R4euQ0917T_0koa-XgzNKnJ5QHasbgIebs4xmd3dPl8_JNOn-8frq2liuJj0CchcopwYA9xKrEqJhcGUaVNNylxyVuRFiYVlpixFJawFU06A60qIONelTcfkdN3befc2YOjVog4Gm0a36Iag0qgqJuKvI3ryB527wbdxuxWVs5RlECm-pox3IXi0qvP1QvulAqa-9Ku1fhX1q5V-xWPoeFM9lAusfiLfviOQroEQR-0L-t-3_6n9BD3KkSk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3132703041</pqid></control><display><type>article</type><title>Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Alapati, Rahul ; Wang, Naomi ; Feucht, Maria ; Ramesh, Uma ; Bon Nieves, Antonio ; Arambula, Alexandra ; Renslo, Bryan ; Lawrence, Amelia ; Wagoner, Sarah F. ; Rouse, David ; Larsen, Christopher</creator><creatorcontrib>Alapati, Rahul ; Wang, Naomi ; Feucht, Maria ; Ramesh, Uma ; Bon Nieves, Antonio ; Arambula, Alexandra ; Renslo, Bryan ; Lawrence, Amelia ; Wagoner, Sarah F. ; Rouse, David ; Larsen, Christopher</creatorcontrib><description>Purpose
Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Methods
Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2–6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
Results
327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (
β
= 3.7, CI [1.3, 7.4], p = 0.038) and increased age (
β
= 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
Conclusions
UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.</description><identifier>ISSN: 1520-9512</identifier><identifier>ISSN: 1522-1709</identifier><identifier>EISSN: 1522-1709</identifier><identifier>DOI: 10.1007/s11325-024-03174-2</identifier><identifier>PMID: 39585419</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Apnea ; Dentistry ; Electric Stimulation Therapy - instrumentation ; Electric Stimulation Therapy - methods ; Electrical stimuli ; Electrodes ; Female ; Humans ; Hypoglossal Nerve ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Otorhinolaryngology ; Patient Compliance ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Polysomnography ; Respiratory tract ; Sleep and wakefulness ; Sleep Apnea, Obstructive - physiopathology ; Sleep Apnea, Obstructive - therapy ; Sleep Breathing Physiology and Disorders • Original Article ; Sleep disorders ; Statistical analysis ; Titration</subject><ispartof>Sleep & breathing, 2025-03, Vol.29 (1), p.6, Article 6</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-1979e96cc12f9edb9e8ce30acd6b7920878be8f0cbb5d5ff1cb612ad556b7abf3</cites><orcidid>0000-0003-1283-382X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11325-024-03174-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11325-024-03174-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39585419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alapati, Rahul</creatorcontrib><creatorcontrib>Wang, Naomi</creatorcontrib><creatorcontrib>Feucht, Maria</creatorcontrib><creatorcontrib>Ramesh, Uma</creatorcontrib><creatorcontrib>Bon Nieves, Antonio</creatorcontrib><creatorcontrib>Arambula, Alexandra</creatorcontrib><creatorcontrib>Renslo, Bryan</creatorcontrib><creatorcontrib>Lawrence, Amelia</creatorcontrib><creatorcontrib>Wagoner, Sarah F.</creatorcontrib><creatorcontrib>Rouse, David</creatorcontrib><creatorcontrib>Larsen, Christopher</creatorcontrib><title>Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?</title><title>Sleep & breathing</title><addtitle>Sleep Breath</addtitle><addtitle>Sleep Breath</addtitle><description>Purpose
Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Methods
Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2–6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
Results
327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (
β
= 3.7, CI [1.3, 7.4], p = 0.038) and increased age (
β
= 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
Conclusions
UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.</description><subject>Aged</subject><subject>Apnea</subject><subject>Dentistry</subject><subject>Electric Stimulation Therapy - instrumentation</subject><subject>Electric Stimulation Therapy - methods</subject><subject>Electrical stimuli</subject><subject>Electrodes</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoglossal Nerve</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Otorhinolaryngology</subject><subject>Patient Compliance</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Polysomnography</subject><subject>Respiratory tract</subject><subject>Sleep and wakefulness</subject><subject>Sleep Apnea, Obstructive - physiopathology</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>Sleep Breathing Physiology and Disorders • Original Article</subject><subject>Sleep disorders</subject><subject>Statistical analysis</subject><subject>Titration</subject><issn>1520-9512</issn><issn>1522-1709</issn><issn>1522-1709</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kL1OwzAURi0EolB4AQZkiYUl4OvETcyCEP9SJRY6W45zDanSONgJqG-PaQtIDEy2dM_3-foQcgTsDBjLzwNAykXCeJawFPIs4VtkDwTnCeRMbq_uLJEC-IjshzBnDLJCwi4ZpVIUIgO5R9Sso-_owxBo5T7aC3rjMFAzWEtDV7dIna-x7XVfu5Zqa9H0FLVvllRXr-ixNUh7R4euQ0917T_0koa-XgzNKnJ5QHasbgIebs4xmd3dPl8_JNOn-8frq2liuJj0CchcopwYA9xKrEqJhcGUaVNNylxyVuRFiYVlpixFJawFU06A60qIONelTcfkdN3befc2YOjVog4Gm0a36Iag0qgqJuKvI3ryB527wbdxuxWVs5RlECm-pox3IXi0qvP1QvulAqa-9Ku1fhX1q5V-xWPoeFM9lAusfiLfviOQroEQR-0L-t-3_6n9BD3KkSk</recordid><startdate>20250301</startdate><enddate>20250301</enddate><creator>Alapati, Rahul</creator><creator>Wang, Naomi</creator><creator>Feucht, Maria</creator><creator>Ramesh, Uma</creator><creator>Bon Nieves, Antonio</creator><creator>Arambula, Alexandra</creator><creator>Renslo, Bryan</creator><creator>Lawrence, Amelia</creator><creator>Wagoner, Sarah F.</creator><creator>Rouse, David</creator><creator>Larsen, Christopher</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1283-382X</orcidid></search><sort><creationdate>20250301</creationdate><title>Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?</title><author>Alapati, Rahul ; Wang, Naomi ; Feucht, Maria ; Ramesh, Uma ; Bon Nieves, Antonio ; Arambula, Alexandra ; Renslo, Bryan ; Lawrence, Amelia ; Wagoner, Sarah F. ; Rouse, David ; Larsen, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-1979e96cc12f9edb9e8ce30acd6b7920878be8f0cbb5d5ff1cb612ad556b7abf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Aged</topic><topic>Apnea</topic><topic>Dentistry</topic><topic>Electric Stimulation Therapy - instrumentation</topic><topic>Electric Stimulation Therapy - methods</topic><topic>Electrical stimuli</topic><topic>Electrodes</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoglossal Nerve</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Otorhinolaryngology</topic><topic>Patient Compliance</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Polysomnography</topic><topic>Respiratory tract</topic><topic>Sleep and wakefulness</topic><topic>Sleep Apnea, Obstructive - physiopathology</topic><topic>Sleep Apnea, Obstructive - therapy</topic><topic>Sleep Breathing Physiology and Disorders • Original Article</topic><topic>Sleep disorders</topic><topic>Statistical analysis</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alapati, Rahul</creatorcontrib><creatorcontrib>Wang, Naomi</creatorcontrib><creatorcontrib>Feucht, Maria</creatorcontrib><creatorcontrib>Ramesh, Uma</creatorcontrib><creatorcontrib>Bon Nieves, Antonio</creatorcontrib><creatorcontrib>Arambula, Alexandra</creatorcontrib><creatorcontrib>Renslo, Bryan</creatorcontrib><creatorcontrib>Lawrence, Amelia</creatorcontrib><creatorcontrib>Wagoner, Sarah F.</creatorcontrib><creatorcontrib>Rouse, David</creatorcontrib><creatorcontrib>Larsen, Christopher</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Sleep & breathing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alapati, Rahul</au><au>Wang, Naomi</au><au>Feucht, Maria</au><au>Ramesh, Uma</au><au>Bon Nieves, Antonio</au><au>Arambula, Alexandra</au><au>Renslo, Bryan</au><au>Lawrence, Amelia</au><au>Wagoner, Sarah F.</au><au>Rouse, David</au><au>Larsen, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?</atitle><jtitle>Sleep & breathing</jtitle><stitle>Sleep Breath</stitle><addtitle>Sleep Breath</addtitle><date>2025-03-01</date><risdate>2025</risdate><volume>29</volume><issue>1</issue><spage>6</spage><pages>6-</pages><artnum>6</artnum><issn>1520-9512</issn><issn>1522-1709</issn><eissn>1522-1709</eissn><abstract>Purpose
Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence.
Methods
Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2–6 months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis. Adherence data was downloaded from the UAS device.
Results
327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1 years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0 h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (
β
= 3.7, CI [1.3, 7.4], p = 0.038) and increased age (
β
= 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence.
Conclusions
UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>39585419</pmid><doi>10.1007/s11325-024-03174-2</doi><orcidid>https://orcid.org/0000-0003-1283-382X</orcidid></addata></record> |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Apnea Dentistry Electric Stimulation Therapy - instrumentation Electric Stimulation Therapy - methods Electrical stimuli Electrodes Female Humans Hypoglossal Nerve Internal Medicine Male Medicine Medicine & Public Health Middle Aged Neurology Otorhinolaryngology Patient Compliance Patients Pediatrics Pneumology/Respiratory System Polysomnography Respiratory tract Sleep and wakefulness Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy Sleep Breathing Physiology and Disorders • Original Article Sleep disorders Statistical analysis Titration |
| title | Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation? |
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