Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi-institutional Review

Objectives/Hypothesis: An elevated body mass index (BMI) influences the severity of disease and treatment options utilized for obstructive sleep apnea (OSA). With this study, we aim to evaluate a cohort of patients undergoing upper airway stimulation (UAS) for treatment of OSA and assess the impact of BMI on surgical and quality of life outcomes. Methods: We designed a case-control, retrospective review, of all patients undergoing UAS at two academic institutions between 2014 and 2017. We compare those with an elevated BMI to those without. We included patients with moderate–severe OSA, who were unable to tolerate therapy with continuous positive airway pressure (CPAP), were treated with UAS, and had a postoperative sleep study performed. We evaluated postoperative sleep study data including apnea-hypopnea index (AHI), O₂ desaturation nadir, rate of cure, and rate of success in those with an elevated BMI to those without an elevated BMI. Success was defined as a drop in the postoperative AHI by 50% compared to the preoperative value and to less than 20. We also assessed daytime sleepiness using the Epworth Sleepiness Scale. Results: When defining an elevated BMI as greater than 32, we found no difference between elevated and nonelevated BMI cohorts in postoperative AHI, O₂ desaturation nadir, daytime sleepiness, rate of surgical success, or rate of cure. Conclusions: Patients with obstructive sleep apnea, unable to tolerate CPAP, and with an elevated BMI can be successfully treated with upper airway stimulation therapy. Level of Evidence: 3. Laryngoscope, 128:2425–2428, 2018.