Correlation Between Cephalometric Values and Quality of Sleep Following Hypoglossal Nerve Stimulation Surgery for the Treatment of Obstructive Sleep Apnea
Jennifer Grauberger*1, Alex Joo1, Yan Lee2, Daniel Plosky4, Jonathan Lee3
1Division of Plastic Surgery, UMass Chan Medical School, Worcester, MA; 2Division of Otolaryngology, Yale School of Medicine, New Haven, CT; 3Division of Plastic Surgery, UMass Chan Medical School Baystate Health, Springfield, MA; 4ENT Surgeons of Western New England, Springfield, MA
Compared to orthognathic surgery, hypoglossal nerve stimulation (HNS) is a newer, less invasive surgical treatment for obstructive sleep apnea (OSA) in those that failed positive airway pressure therapy. Although HNS has shown long-term reduction in apnea-hypopnea index (AHI) scores and improved quality of sleep, many patients don't respond to treatment. Optimized patient selection is needed. Our goal was to study the association between cephalometric values and OSA symptom improvement following HNS.
A single-center retrospective cohort study of 24 adult patients who underwent HNS (2019-2022). Standard cephalometric values were obtained using post-operative lateral neck x-rays. A telephone survey of quality of life and sleep including the Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) was conducted. Univariate analyses used Wilcoxon Signed-Rank Test and Spearman's Rho.
Reported as median value[IQR]. Patient age was 58.6[48.8-66.5] years with BMI of 28.9[27.1-31.9]. The baseline AHI score was 29[21.3-39.2] with a change of -8.6[-28.3-0.2] (P=0.0441). Baseline ESS score was 11[5.5-15.0] with a change of -6[-9.8-2.0] (P=0.0010). Post-procedure survey participation was 70.8% with follow-up of 377[258-594] days. Increased sella-nasion-B-point (SNB) angle (78.5[76.8-81.0] degrees) was associated with improved FOSQ-10 (R=-0.9 and R=0.9, P=0.0379 for both). Greater mandibular length (13.8[12.9-14.5] cm) was associated with lower baseline ESS (R=-0.4, P=0.0398), and greater improvement at titration (R=-0.6, P=0.0142) and survey (R=-0.6, P=0.0172). No cephalometric values were significantly associated with AHI.
Patients who underwent HNS had significant improvement in both objective and subjective OSA symptoms, similar to other studies. However, those with smaller SNB angles and shorter mandibles did not have a significant change in AHI and may benefit more from orthognathic surgery. To better counsel patients with OSA on treatment options, lateral cephalometric x-rays should be obtained as part of their initial work-up.
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