{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:56:06Z","timestamp":1789102566277,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Upper airway stimulation (UAS) is a treatment option for obstructive sleep apnea\u00a0in which electrical stimulation is applied to the hypoglossal nerve. Nerve branches that control tongue protrusion are located inferiorly. Due to positioning, left\u2010sided implants are typically placed with an inferiorly oriented electrode cuff (L\u2010down) as opposed to superiorly on the right (R\u2010up). In this study, we assess the impact of left\u2010 versus right\u2010sided UAS on patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary Academic Medical Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who underwent UAS implantation between 2016 and 2021 with an L\u2010down or R\u2010up oriented cuff as confirmed by X\u2010ray were included. Data were collected retrospectively. Most recent sleep study variables were used for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 190 patients met the inclusion criteria. The average age was 61.0\u2009\u00b1\u200911.0 years, with 55 (28.9%) females. L\u2010down orientation was present in 21 (11.1%) patients vs 169 (88.9%) R\u2010up. Indications for L\u2010down included hunting\/shooting (n\u2009=\u200915), prior radiation\/surgery (n\u2009=\u20094), central port (n\u2009=\u20091), and brachial plexus injury (n\u2009=\u20091). Adherence was higher among L\u2010down patients (47.1 vs\u00a041.0 hours use\/week, <jats:italic>P<\/jats:italic>\u2009=\u2009.037) in univariate analysis, with a similar time to adherence data collection (4.4 vs\u00a04.2 months, <jats:italic>P<\/jats:italic>\u2009=\u2009.612), though this finding was not maintained in the multivariate regression analysis. Decrease in apnea\u2010hypopnea index (21.3 vs\u00a022.8, <jats:italic>P<\/jats:italic>\u2009=\u2009.734), treatment success (76.5% vs\u00a084.0%, <jats:italic>P<\/jats:italic>\u2009=\u2009.665), functional threshold (1.5 vs\u00a01.6, <jats:italic>P<\/jats:italic>\u2009=\u2009.550), therapeutic amplitude (2.3 vs\u00a02.4, <jats:italic>P<\/jats:italic>\u2009=\u2009.882), and decrease in Epworth Sleepiness Scale (4.9 vs\u00a02.6, <jats:italic>P<\/jats:italic>\u2009=\u2009.060)\u00a0were not significantly different between cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study is the first to examine the orientation of the UAS electrode cuff concerning the electrodes' natural position and the potential effect on postoperative outcomes. Our study found no significantly different treatment outcomes between the L\u2010down versus R\u2010up cohort, with the exception of device adherence, which was significantly higher in the L\u2010down group on univariate analysis though not on multivariate analysis. Future studies with larger patient cohorts are needed to further investigate this potential relationship between treatment outcomes and electrode cuff orientation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.668","type":"journal-article","created":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T05:51:22Z","timestamp":1706939482000},"page":"1183-1189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Right Versus Left Cuff Position for Upper Airway Stimulation"],"prefix":"10.1002","volume":"170","author":[{"given":"Alexandra M.","family":"Arambula","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Case Western Reserve University\/University Hospitals Cleveland Ohio 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