Predicting Candidacy for Unilateral Hypoglossal Nerve Stimulation Without Drug‐Induced Sleep Endoscopy

AbstractObjectivePatients undergo a drug‐induced sleep endoscopy before unilateral hypoglossal nerve stimulation. This study aims to reduce the need for preoperative drug‐induced sleep endoscopy by predicting favorable collapse patterns at the velum based on clinical examination and sleep study data.Study DesignA retrospective cohort study.SettingA single‐center trial.MethodsDrug‐induced sleep endoscopy recordings were scored by a blinded rater, and the palatal collapse pattern was classified as favorable (no or anterior–posterior) or unfavorable (lateral or concentric), irrespective of collapse degree. Logistic regression models were constructed using clinical examination and sleep data to predict palatal collapse patterns. Model performance was assessed using receiver‐operating characteristic curves and validated internally using bootstrapping and externally using a separate cohort.ResultsRecordings of 250 patients were analyzed, of which 118 showed a favorable palatal collapse pattern. Lower body mass index (BMI), lower tonsil grade, and less intense bed‐partner‐reported snoring were significant predictors of favorable collapse patterns (area under the curve [AUC] 0.70). A further reduction in tonsil grade and BMI resulted in similar model performance (AUC 0.68). In patients with no tonsils and BMI < 28 kg/m2 or tonsil grade 1 and BMI < 24 kg/m2, a favorable collapse was correctly predicted in 81%. In external validation, favorable collapse was correctly identified in 91%.ConclusionFavorable palatal collapse can accurately be predicted in patients with small or absent tonsils and low BMI. Before unilateral hypoglossal nerve stimulation implantation, a drug‐induced sleep endoscopy might not be necessary in this subset of patients.