Impulse configuration in Upper-Airway-Stimulation in Obstructive Sleep Apnea – Get more tongue protrusion for less voltage?

Selective Upper-Airway-Stimulation (sUAS) is regarded as a well-established therapy option for obstructive sleep apnea (OSA) in PAP failure. The electric impulse provokes tongue protrusion whereas this impulse consists of numerous mini bursts. Standard settings for length and frequency of such a burst are 90µs and 33 Hz. A more intense impulse with 120µs and 40 Hz results in a tongue protrusion at a larger extent. The aim of this study was to analyse whether a reduced voltage with a comparable tongue protrusion is connected with a larger range of voltage steps.

Patients from a follow-up cohort were recruited who had been implanted (Inspire Medical Systems) for at least 12 months. Beside respiratory outcome parameter, functional (FT) and sub-discomfort threshold (ST) have been registered for bipolar and unipolar electrode configurations (EK).

Within 15 months, 74 patients were included and showed at the individually varying time point of follow-up (12 up to 60 months) a therapy success of 71% regarding an apnea-hypopnea index below 20/h. At 90µs 33 Hz, median FT was 1.5 V for bipolar and 0.8 V resp. 0.55 V for unipolar EK (Off – Off, – -). For 120µs 40 Hz, median FT for bipolar was 0.8 V and for unipolar EK 0.7 V resp. 0.4 V. The range between FT and ST was larger for 120µs 40 Hz in bipolar EK than 90µs 33 Hz setting (p < 0.01) but not for unipolar EK (p = 0.690 resp. 0.947).

If patients cannot tolerate the needed voltage at standard impulse settings, a change to more intense impulse configuration could provide a better tolerable voltage with a potentially larger range of voltage steps at bipolar EK.

Stephanie Jeschke

UKSH Campus Lübeck, Klinik für HNO-Heilkunde,

Ratzeburger Allee 160, 23538

Lübeck

Email: [e-mail]

Publication History

Publication Date:
23 April 2019 (online)