Respiratory Sensing Lead Malfunction in Upper Airway Stimulation: A Single Institution Report

ObjectivesUpper airway stimulation (UAS) is an effective treatment for patients with obstructive sleep apnea. The device consists of a stimulating electrode, an internal pulse generator, and a respiratory sensing lead. The purpose of this study is to characterize the incidence of sensing lead malfunction necessitating revision surgery in a high-volume center in conjunction with a review of the FDA Manufacturer and User Facility Device Experience (MAUDE) database reports on adverse events associated with the sensing lead component.MethodsPatients age & GE;18 implanted with the device were reviewed between July 2017 and June 2022. Those determined to have sensing lead malfunction were analyzed. The FDA MAUDE database was reviewed for reports associated with "Inspire Model 4323 Respiratory" and "Inspire Model 4340 Respiratory" between January 2014 and September 2022.ResultsOne hundred ninety patients underwent UAS at our institution during the study period and four (2.1%) patients were found to have sensing lead malfunction. Analysis of the MAUDE database revealed 122 reports of adverse events associated with the sensing lead component, with 72% (88/122) of these requiring revision surgery. The most frequently reported adverse event was sensing lead tip separation from lead body, noted in 46% of these reports (56/122).ConclusionThe functionality of the sensing lead component is vital to the integrity of the UAS device and is measurable through waveform analysis. To provide optimal care after device implantation, it is essential to have a comprehensive understanding of the scenarios in which this component fails, the incidence of such events, and appropriate management.Level of Evidence4 Laryngoscope, 2023 This study investigates the incidence of sensing lead malfunction with the Inspire device for obstructive sleep apnea, utilizing a retrospective review of 190 patients from a single institution as well as reviews adverse events associated with the sensing lead component via an analysis of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Results indicate a 2.1% rate of sensing lead malfunction, with cases demonstrating internal component issues and sensing lead tip separation. Such malfunctions put patients at risk for migration of the isolated tip, emphasizing the importance of understanding failure scenarios for optimal patient management.image