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Home sleep testing with peripheral arterial tonometry to assess outcome in upper airway stimulation.

STUDY OBJECTIVES
To determine whether home sleep testing with peripheral arterial tonometry (HST-PAT) can be used in upper airway stimulation (UAS) to evaluate therapy success.


METHODS
Data analysis from 50 consecutive UAS patients was performed. Baseline values were measured by polysomnography (PSG) and HST-PAT. Follow-up was performed during and after titration (3- to 6-months) by PSG and HST-PAT and after 1 year by HST-PAT only. Primary outcome measures were reduction in apnea-hypopnea-index (AHI) and oxygen-desaturation-index (ODI). Additionally, an analysis of night-to-night variability (NNV) for HST-PAT was performed.


RESULTS
All 50 patients completed their post-titration visit (3- to 6-months) and 41 patients the 1-year follow up. In HST-PAT after 1-year, mean AHI (desaturation 3%) was reduced from 29.5±17.1 ﻿ to 19.9±13.1 (p<0.01) and ODI (desaturation 4%) from 17.8±12.6 ﻿ to 10.2±8.3 (p<0.01). Therapy adherence after 1-year was high (6.6 ± 1.9 hours per night) and led to improvement in daytime sleepiness, meaning a reduction in Epworth sleepiness scale from 12.8 ± 5.4 ﻿ to 5.9 ± 4.0 (p < 0.01). Analysis of NNV showed similar AHI values between the two nights.


CONCLUSIONS
UAS was able to reduce AHI and ODI after 1-year, assessed by full-night efficacy studies with HST-PAT. Additionally, improvements in subjective outcome parameters were observed. The importance of publishing the scoring criteria is highlighted and whether data is based on full-night efficacy studies or a selected period of time from a sleep study. This is a prerequisite for comparing data with other trials in the emerging field of UAS.