Care Pathway
What criteria must be met when opting for Fine Tune HSAT vs. PSG?
6+ hours of usage, positive subjective benefit with SleepSync confirmation, no over-stimulation suspected
How many patients were enrolled in the STAR trial?
126
What is the average level patients step up to in the first few months leading up to their fine tune sleep study?
Level 7-8
3 differences between Inspire therapy & Genio therapy?
Patient experience, bilateral vs. unilateral stimulation, incisions, established care pathway, sensing component, BMI criteria, clinical evidence
What is the next step for a patient who opted for a Fine Tune HSAT (met all criteria) that came back yellow for high AHI?
In-lab PSG
What is SHER 20 criteria?
AHI reduced by at least 50% from baseline & residual AHI <20
Criteria for increasing a patient's amplitude range? (4 things)
Top of remote level, not feeling subjective benefit, great usage, sub-optimal tongue motion
What is the recommended infusion pump rate of propofol for DISE procedures?
100 mcg/kg/min
What are the 3 Airway Potential Tests we assess in an awake endoscopy?
Oral vs. Nasal Breathing
Neck Flexion
Jaw Thrust
Name 3 ways in which AHI & hypoxic burden differ
AHI: available in all sleep studies, current standard metric of OSA severity, measures frequency of breathing events without specificity
HB: becoming more available in sleep study technology, incorporates depth, duration & frequency of oxygen desaturations, focus is on physiologic impact of events rather than only frequency, closely linked to CV outcomes & physiological stress
Provide 5 examples of patient complaints/ scenarios that you'd consider red flags for potential over-stimulation
Increased over 1V since activation, discomfort with stimulation, stimulation waking them up, increased pausing, decreased usage, now an oral breather, new dry mouth, new tongue abrasion, decreased subjective benefit compared to earlier on with therapy, increased central apneas on titration study, overly robust tongue motion
Which IPG model numbers are approved for 3T MRI (conditional)?
3028 & 3150
3 possible causes of no tongue motion at activation
MDA is an impactful metric to compare outcomes between Inspire & PAP therapy as it combines both efficacy & adherence. What does it stand for and how is it calculated?
Mean Disease Alleviation
MDA = efficacy x adherence
ie CPAP patient:
reduces AHI from 30 to 3, efficacy= 90%
usage is only 50% over 4 hours
0.90x0.50=0.45
Per our titration sleep study training recommendation - the minimum amount of time to be spent at each amplitude before increasing
10 minutes (20-30 minutes is good practice)
In neck dissection - tissue order from superficial to deep
digastric tendon, mylohyoid muscle, hypoglossal nerve, hyoglossus muscle
Conducting a system check - describe the differences in measuring impedances, Inspire IV compared to Inspire V
Both involve 5 impedance measurements.
Inspire IV: will measure 1.5V-3.0V & patient will usually feel 3 pulses. Order matters.
Inspire V: no amplitude requirement & patient may feel mild stim. Order doesn't matter, checking for matching >7000 or any<200 or ---.
According to the secondary analysis of the STAR trial (Xu et. al., 2026) this percentage of high hypoxic burden patients transitioned to the low hypoxic burden category
81%
Name & describe the 3 interactions for over-stimulation (aka how it affects the body)
1) Anatomical- airway closure (overstretched), oral breathing (increased upper airway resistance)
2) Neurological - brain arousal (disrupted sleep), discomfort
3) Physiological - disrupted respiratory loop gain, leads to treatment emergent central sleep apnea
What 4 things are we verifying before moving forward with a routine generator change? (aka ruling out the possibility of replacing other components)
1. Patient reported outcomes
2. Objective usage & outcomes
3. System ability to provide functional tongue motion
4. Intact sense lead/ no waveform abnormalities