Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update
Maria V. Suurna, Armin Steffen, Maurits Boon, Eugene Chio, Marcel P. Copper, Reena Dhanda Patil, Katherine Green, Ronald D. Hanson, Clemens Heiser, Colin Huntley, David T. Kent, Christopher G. Larsen, Shalini Manchanda, Joachim T. Maurer, Ryan J. Soose, Nico de Vries, Harneet K. Walia, Erica R. Thaler, ADHERE Registry Investigators
Abstract
Objectives/Hypothesis To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. Study Design Prospective observational study. Methods ADHERE captures UAS outcomes including apnea‐hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1‐year period. BMI ≤32 kg/m 2 (BMI 32 ) and 32 < BMI ≤35 kg/m 2 (BMI 35 ) group outcomes were examined. Results One thousand eight hundred forty‐nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (−20.9, P < .0001) and ESS (− 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI 35 versus BMI 32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI 32 versus 5.2 ± 2.2 hr/day in BMI 35 ( P = .028). Conclusions Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI 32 and BMI 35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. Level of Evidence 4 Laryngoscope , 131:2616–2624, 2021