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Otolaryngol Head Neck Surg. 2018 Aug;159(2):379-385. doi: 10.1177/0194599818764896. Epub 2018 Mar 20.

Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry.

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1 Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
2 University of Lubeck, Lubeck, Germany.
3 University-Hospital Mannheim, Mannheim, Germany.
4 University of Pennsylvania, Philadelphia, Pennsylvania, USA.
5 University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
6 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
7 MedStar Washington Hospital Center, Washington, DC, USA.
8 University of Alabama, Birmingham, Alabama, USA.
9 University Hospital Cleveland, Cleveland, Ohio, USA.
10 Technical University of Munich, Munich, Germany.


Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients' symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.


OSA; obstructive sleep apnea; sleep apnea; upper airway stimulation


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