0680 Evaluating Alternatives: Insights from Drug-Induced Sleep Endoscopy in Women with REM-Predominant Obstructive Sleep Apnea

Abstract Introduction Moderate to severe rapid eye movement (REM)-related Obstructive Sleep Apnea (OSA) presents unique treatment challenges, particularly for patients unresponsive to standard therapies. This case series describes 20 women with REM predominant OSA who underwent Drug-Induced Sleep Endoscopy (DISE) to assess suitable alternatives to positive airway pressure (PAP) therapy. Methods We identified a cohort of 20 women aged 36 to 73 years with a BMI ranging 25 to 35 kg/m2 who underwent DISE and had predominantly mild to moderate OSA by total AHI but moderate to severe REM OSA (total AHI range 5.6-44.7/hr vs REM AHI range 19-93/hr on baseline study). Results Of the 20 patients, 18 showed significant anterior-posterior (AP) collapse of the velum and base of the tongue during DISE while 2 patients exhibited complete circumferential collapse of the velum. Out of the 18 patients, 16 had complete AP collapse at both sites and 5 had partial (< 50%) lateral wall collapse of the hypopharynx. Among this cohort, 13 patients proceeded with hypoglossal nerve stimulator (HGNS) implantation; one required additional intervention which included nasal septoplasty along with hyoid suspension due to persistent lateral wall collapse of the hypopharynx. Of the remaining seven patients, one received a mandibular advancement device, three underwent turbinate reduction and septoplasty, one had uvulopalatopharyngoplasty (UPPP), and two continued with PAP therapy. Significant improvements were observed in both total and REM AHI on repeat polysomnogram (PSG) after HGNS treatment. Monotherapy with UPPP, turbinate reduction, or septoplasty did not yield significant improvements in AHI; however, when utilized as part of a multimodal approach, a marked reduction in AHI was noted. Those patients who chose to continue PAP therapy displayed continued poor adherence, resulting in ongoing untreated OSA. Conclusion DISE provides crucial insights into specific patterns of airway collapsibility in women with moderate to severe REM OSA. The results demonstrate that personalized treatment strategies, particularly HGNS and targeted surgical interventions, can lead to significant improvements in outcomes of PAP-intolerant patients. Our findings highlight the need for further research to refine and optimize treatment approaches to ensure that treatment for women should be tailored not only to total AHI but also REM AHI. Support (if any)