Reena Mehra, MD, MS: ADHERE Cohort Gender Findings

New findings from the two-year, international-based ADHERE cohort found that upper airway stimulation (UAS)—a form of obstructive sleep apnea (OSA) care on the rise in the US—is actually more beneficial for female patients than male patients.

Though the cohort—presented at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX— also found that patients with lower body mass index and greater adherence rates also benefit more significantly from OSA, its particular benefit for women is a novel finding. In an interview with MD Magazine® at ATS, study author Reena Mehra, MD, MS, director of the Sleep Disorders Center at the Cleveland Clinic, explained the significance of the new ADHERE data, and how it could influence the evolving state of OSA therapies.

MD Mag: What were the critical findings from the ADHERE cohort assessment?

Mehra: So sleep apnea is a very common disorder involving repetitive upper airway collapse. And the standard treatment for sleep apnea is continuous positive airway pressure, or CPAP. CPAP, however, is associated with difficulties in tolerating the device and the pressure, and is associated therefore with compliance that's somewhat suboptimal.

So there have been innovative, novel therapies that have come to light to offer an alternative to positive airway pressure in the treatment of obstructive sleep apnea. An upper airway neurostimulation is one of those therapies. It involves implantation of a device with the lead that goes to the hypoglossal nerve that innervates the tongue, to stimulate the nerve, to therefore activate the genioglossus muscle and cause opening of the airway.

So this is a novel therapy, and we are discussing findings related to this therapy in terms of trying to identify predictors of success of this therapy. And we essentially looked for any characteristics that could identify those that would do well with the therapy. And we looked at age, gender, body mass index, and other characteristics, as well including baseline severity of obstructive sleep apnea as defined by the Apnea Hypopnea Index.

And what we found was that it appeared that women had better responsivity to upper airway neurostimulation compared to men—which is a novel finding. And we also identified that those who are with lower body mass index tended to do better as well, and this is something that had already been recognized. The original pivotal clinical trial even targeted those with a body mass index of less than 32 kilograms per meter².

But the novel finding really is that women tend to have better upper airway neurostimulation responsiveness compared to men, and this is even after we took into consideration other confounding factors such as age and other characteristics—and even duration of therapy. We defined the responsibility based upon the extent of improvement in the Apnea Hypopnea Index, which is the traditional measure of the severity of obstructive sleep apnea, and then found that women did better.

The study, "Phenotypic Predictors of Long-Term Upper Airway Neurostimulation Responsiveness in the ADHERE International Cohort," was presented at ATS 2019.