0571 Comparison Of Ahi And Ess Outcomes Between Patients Undergoing Palatal Surgery Versus Upper Airway Stimulation Adhere Registry

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CPAP intolerance occurs in 30-50% of obstructive sleep apnea patients, and some seek surgical alternatives. Palatal surgery is a common alternative. Upper Airway Stimulation (UAS), using an implantable hypoglossal nerve stimulator is another recent option. We retrospectively compared post-operative outcomes between the two methods. Palatal surgery (PS) was defined as either uvulopalatopharyngoplasty or expansion pharygoplasty. Patients who underwent palatal surgery, and would have met general UAS criteria (BMI ≤35 and AHI between 15-65) were selected for chart review. UAS outcomes were collected from the ADHERE multi-center international registry. Demographics, baseline and post-operative outcomes were compared. Data are presented as mean and standard deviation. (90% vs 76%), and overweight (PS-BMI: 29 ± 3 vs. UAS-BMI: 29 ± 4, p=0.50). The palatal surgery cohort was younger than the UAS cohort (46 ± 11 vs 61 ±11 years, p<0.001), perhaps reflecting concerns of airway surgery post-operative complications in an older population. At baseline, both cohorts had severe, symptomatic OSA. PS patients had a non-significant trend towards lower pre-op AHI than UAS. (PS-Baseline AHI: 33 ± 13 vs UAS-Baseline AHI:36 ± 16, p=0.09). Baseline ESS were similar (PS-ESS: 11 ± 5 vs. UAS-ESS: 12 ± 5, p=0.31). After similar follow-up intervals (153 ±106 vs 147 ± 95days, p=0.74), UAS recipients had a significantly larger decrease in AHI than the PS group (-25 ±18 events/hour vs. -15 ± 17events/hour, p<0.00001). UAS recipients also had a slightly larger decrease in ESS, (-4 ± 5vs -3 ± 5), but the difference was not statistically significant (p=0.12). Using the Sher surgical success criteria (50% decrease in AHI and ≤20 events/hour), UAS had a 75% success rate vs 52% palatal surgery success. Despite similar baseline disease severity and demographics, UAS reduces the AHI significantly more than palatal surgery, and with a higher surgical success rate. ESS was equally reduced by both therapies. These findings warrant further prospective research. This clinical trail (ADHERE registry) is supported by Inspire Medical Systems

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