1024 A Challenging Inspire Case: All Roads Do Not Necessarily Lead to Rome
نویسندگان
چکیده
Abstract Introduction Hypoglossal nerve stimulation (HNS) for the treatment of obstructive sleep apnea (OSA) in patients who have failed positive airway pressure (PAP) therapy one reason or other is now standard care. Once device implanted and activated, voltage to stimulate has be titrated over time, ultimately leading an HNS titration study. There are 4 possible electrode configurations different fibers that can employed treatment. We present a case patient was challenge with worsening OSA Inspire. Report case(s) A 65-year-old woman hypertension, severe OSA, intolerant oral appliances Post activation, there symptomatic improvement reduction overall apnea-hypopnea index (AHI) from 34 per hour 6.3 hour. However, slept exclusively on sides evidence significant residual disease REM sleep. During subsequent weeks, patent reported inability restrict position discomfort anxiety associated up titration. Both awake endoscopy advanced overnight were pursued. All tested during both procedures. With exception (minus-plus-minus) configuration, disordered breathing higher AHI 60 polysomnography poor tongue motion collapsed velopharynx endoscopy. Inspire settings readjusted configuration instructions very slow outpatient uptitration co-management anxiolytics aids. Conclusion make two important conclusions this case. Firstly, although established criteria selection hypoglossal therapy, certain factors impact success which not as easily defined include patients’ expectations, tolerance discomfort, propensity personality type ability successfully titrate time. Secondly, complex muscle, under may counterproductive additionally, also varying effects protrusion success. Support (if any)
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ژورنال
عنوان ژورنال: Sleep
سال: 2023
ISSN: ['0302-5128']
DOI: https://doi.org/10.1093/sleep/zsad077.1024