0615 DISE-Cryotherapy a Novel Treatment for Patients with Obstructive Sleep Apnea

Abstract

Abstract Introduction Drug induced sleep endoscopy (DISE) can provide valuable information about the level (VOTE), pattern and degree of upper airway obstruction in patients with obstructive sleep apnea (OSA). Integrating DISE with cryotherapy can provide a novel and successful treatment for OSA patients. The objective of this study was to examine safety and efficacy of a novel DISE-Cryotherapy technique in treating OSA. Methods A prospective single-arm interventional trial was done after institution review board approval and formal patient consent. Thirty adult subjects with confirmed OSA underwent DISE and cryotherapy in two sessions with two weeks interval using a flexible cryocanalization probe (78 cm in length/2.4 mm in diameter, ERBE, Medizintechnik GmbH, Tübingen, Germany) with cryomachine (ERBECRYO CA, ERBE, Tübingen, Germany). Polysomnogram (PSG) was done pre-intervention and repeated 12-weeks post-intervention. Primary outcomes were reduction in baseline DISE score and apnea hypopnea index (AHI), and improvements in excessive daily sleepiness (EDS) and other OSA related symptoms. Patients follow up was done at two-weeks and, and 12-weeks post-intervention. Results Twenty men and 10 women with OSA were included in the study. There mean (SD) age and BMI were 42.57(9.52) years and 32.28 (3.19), respectively. Preoperative Mallampati, tonsillar size and VOTE mean scores were 2.4 (0.49), 1.33 (0.47) and 2.7 (1.02) respectively. Preoperative mean AHI and desaturation index were 31.10 (19.15) and 29.01(20.40), respectively. A two-week post cryotherapy evaluation showed reduction in the mean of VOTE score to 1.6 (0.93) and significant improvements in all sleep related clinical symptoms. Twelve-week post cryotherapy assessment revealed a significant reduction in the mean AHI, and desaturation index to 10.07 (7.65), and 10.3(8.33) respectively. The median (range) of percentage reduction in baseline AHI was 71.36% (42.05-86.38). Above 50% reduction in baseline AHI was achieved in 90% of patients with a mean of 70.63%, while only 10% showed 20-50% reduction with a mean of 45.78%. Significant independent predictors for percentage reduction were age and preoperative total VOTE score. No immediate or remote side effects were reported. Conclusion Cryotherapy is a safe and promising intervention for treatment of OSA patients. Support (if any) No