Treatment of a floppy epiglottis with upper airway stimulation therapy

• Published in: European archives of oto-rhino-laryngology Vol. 281; no. 1; pp. 461 - 467
• Main Authors: Kant, E., Hardeman, J. A., Stokroos, R. J., Copper, M. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2024
• Subjects: Cohort Studies; Electric Stimulation Therapy - adverse effects; Epiglottis; Head and Neck Surgery; Humans; Medicine; Medicine & Public Health; Miscellaneous; Neurosurgery; Otorhinolaryngology; Retrospective Studies; Sleep Apnea, Obstructive - surgery; Treatment Outcome; Epiglottis; Drug-induced sleep endoscopy; Floppy epiglottis; Upper airway stimulation; Hypoglossal nerve stimulation
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-023-08268-3

Purpose
To evaluate the efficacy of upper airway stimulation therapy in patients with a floppy epiglottis who have experienced continuous positive airway pressure failure or intolerance.
Methods
A retrospective single-center cohort study was conducted. Patients who received an Inspire Upper Airway Stimulation system and had a 1-year follow-up were included. Baseline and one-year in-laboratory polysomnography examinations were performed. Patient characteristics, Epworth Sleepiness Scale scores and upper airway stimulation device settings were collected.
Results
A total of 75 patients were included, of whom 10 had a floppy epiglottis. Patients with a floppy epiglottis had a significant therapeutic response to upper airway stimulation therapy, similar to patients without a floppy epiglottis. According to the Sher’s success criteria, 90% of patients with a floppy epiglottis and 68% of patients without a floppy epiglottis were responders to therapy (
p
 = 0.149). In the floppy epiglottis group, the apnea–hypopnea index decreased from 35.1 ± 5.5 events/hour to 11.2 ± 11.3 events/hour (95% CI (15.0, 32.9),
p
 < 0.001), similarly in the non-floppy epiglottis group, the decline was from 36.4 ± 8.3 events/hour to 14.4 ± 9.5 events/hour (95% CI (18.6, 25.2),
p
 < 0.001, between groups
p
 = 0.659). Comparable reductions were observed for the other respiratory parameters.
Conclusion
Treatment of patients with obstructive sleep apnea and a floppy epiglottis can be challenging. Continuous positive airway pressure may aggravate the epiglottis collapse. Upper airway stimulation therapy can be considered an effective alternative treatment option for patients with a floppy epiglottis who have encountered either continuous positive airway pressure failure or intolerance.