{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:02:14Z","timestamp":1789513334198,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL144859"],"award-info":[{"award-number":["R01HL144859"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32HL170968"],"award-info":[{"award-number":["T32HL170968"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>To evaluate the relationship between physiologic mechanisms under drug-induced sleep endoscopy (DISE) and polysomnographic response to hypoglossal nerve stimulation (HGNS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In an NIH-funded interventional trial, 30 subjects with HGNS devices underwent DISE with pneumotachometer, pharyngeal manometry, and positive airway pressure titration. On the previous night, subjects underwent a split-night polysomnogram (first portion without HGNS and second at a single clinically-determined voltage) in the supine position. Responder status was determined by a 50% reduction in supine apnea\u2013hypopnea index (AHI). Groups (responders vs. nonresponders) were compared using the Wilcoxon Rank Sum Test, and Spearman\u2019s rho was used to assess correlations between physiologic mechanisms under DISE and polysomnographic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients (n\u00a0=\u200930) were generally older (64.3\u2009\u00b1\u20098.9\u00a0years), female (56.7%), and overweight (body mass index 28.1\u2009\u00b1\u20093.1\u00a0kg\/m2) with severe obstructive sleep apnea (supine AHI 47.7\u2009\u00b1\u200925.4 events\/hour). Among 14 responders and 16 nonresponders, there was no statistical difference in baseline collapsibility (pharyngeal opening pressure, 5.9\u2009\u00b1\u20092.4 vs 7.2\u2009\u00b1\u20093.7 cmH2O, p\u00a0=\u20090.39) or baseline inspiratory epiglottic pressure (Pepi, \u2212 17.2\u2009\u00b1\u20099.0 vs \u2212 18.6\u2009\u00b1\u200912.8 cmH2O, p\u00a0=\u20090.99). Improvements in collapsibility (rho\u2009=\u20090.70, p\u00a0=\u20090.0001) and inspiratory Pepi (rho\u2009=\u2009\u22120.70, p\u00a0=\u20090.0001) with HGNS were strongly associated with reduction in supine AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this small interventional study, decreases in collapsibility and effort during DISE are markers of clinical response to HGNS therapy. Our novel findings demonstrate responses to acute physiologic interventions during DISE translate to natural sleep outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial<\/jats:title>\n                    <jats:p>\u201cCharacterizing Mechanisms of Upper Airway Obstruction During Drug-Induced Sleep Endoscopy (DISE)\u201d, https:\/\/clinicaltrials.gov\/study\/NCT04322097, Registration No: NCT04322097<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag227","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:20:46Z","timestamp":1787570446000},"source":"Crossref","is-referenced-by-count":0,"title":["Physiologic mechanisms of response to hypoglossal nerve stimulation"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-4852","authenticated-orcid":false,"given":"Linda C","family":"Maga\u00f1a","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]},{"name":"Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1524-5292","authenticated-orcid":false,"given":"Yash","family":"Dixit","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Saconi","sequence":"additional","affiliation":[{"name":"Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9070-847X","authenticated-orcid":false,"given":"Brendan T","family":"Keenan","sequence":"additional","affiliation":[{"name":"Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everett G","family":"Seay","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9222-3751","authenticated-orcid":false,"given":"Alan R","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]},{"name":"Department of Otolaryngology, Vanderbilt University School of Medicine , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-0427","authenticated-orcid":false,"given":"Raj C","family":"Dedhia","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head & Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]},{"name":"Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"issue":"9464","key":"2026091518062282700_ref1","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study","volume":"365","author":"Marin","year":"2005","journal-title":"The Lancet"},{"issue":"9","key":"2026091518062282700_ref2","doi-asserted-by":"publisher","first-page":"e2432468","DOI":"10.1001\/jamanetworkopen.2024.32468","article-title":"Positive airway pressure, mortality, and cardiovascular risk in older adults with sleep apnea","volume":"7","author":"Mazzotti","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"2","key":"2026091518062282700_ref3","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1056\/NEJMoa1308659","article-title":"Upper-airway stimulation for obstructive sleep apnea","volume":"370","author":"Strollo","year":"2014","journal-title":"N Engl J Med"},{"issue":"1","key":"2026091518062282700_ref4","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1177\/0194599818762383","article-title":"Upper airway stimulation for obstructive sleep apnea: 5-year outcomes","volume":"159","author":"Woodson","year":"2018","journal-title":"Otolaryngology"},{"issue":"1","key":"2026091518062282700_ref5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.5664\/jcsm.11328","article-title":"How we measure hypoglossal nerve stimulator outcome matters: titration vs single amplitude efficacy sleep studies","volume":"21","author":"Kaffenberger","year":"2025","journal-title":"J Clin Sleep Med"},{"key":"2026091518062282700_ref6","doi-asserted-by":"publisher","first-page":"107750","DOI":"10.1016\/j.rmed.2024.107750","article-title":"Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea","volume":"232","author":"Pordzik","year":"2024","journal-title":"Respir Med"},{"issue":"5","key":"2026091518062282700_ref7","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1001\/jamaoto.2024.0261","article-title":"Response to hypoglossal nerve stimulation changes with body mass index and supine sleep","volume":"150","author":"Patel","year":"2024","journal-title":"JAMA Otolaryngol"},{"issue":"1","key":"2026091518062282700_ref8","doi-asserted-by":"publisher","first-page":"98","DOI":"10.3390\/biology12010098","article-title":"Insomnia in patients undergoing hypoglossal nerve stimulation therapy for obstructive sleep apnea","volume":"12","author":"Pordzik","year":"2023","journal-title":"Biology (Basel)"},{"issue":"8","key":"2026091518062282700_ref9","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1001\/jamaoto.2020.1018","article-title":"Evaluation of therapeutic positive airway pressure as a hypoglossal nerve stimulation predictor in patients with obstructive sleep apnea","volume":"146","author":"Seay","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"08","key":"2026091518062282700_ref10","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.5664\/jcsm.7814","article-title":"Therapeutic positive airway pressure level predicts response to hypoglossal nerve stimulation for obstructive sleep apnea","volume":"15","author":"Lee","year":"2019","journal-title":"J Clin Sleep Med"},{"issue":"5","key":"2026091518062282700_ref11","doi-asserted-by":"publisher","first-page":"2023","DOI":"10.1152\/japplphysiol.00203.2003","article-title":"Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea","volume":"95","author":"Oliven","year":"2003","journal-title":"J Appl Physiol"},{"issue":"4","key":"2026091518062282700_ref12","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1002\/ohn.1354","article-title":"Ascending and descending pharyngeal opening pressures during drug-induced sleep endoscopy: mechanistic insights for sleep surgeons","volume":"173","author":"Maga\u00f1a","year":"2025","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"4","key":"2026091518062282700_ref13","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1159\/000518660","article-title":"Beyond VOTE: the new frontier of drug-induced sleep endoscopy","volume":"84","author":"Dedhia","year":"2022","journal-title":"ORL J Otorhinolaryngol Relat Spec."},{"key":"2026091518062282700_ref14","volume-title":"The AASM Manual for the Scoring of Sleep and Associated Events, Version 3","author":"Troester","year":"2023"},{"issue":"2","key":"2026091518062282700_ref15","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s11325-026-03665-4","article-title":"Translating hypoglossal nerve stimulation tongue movement into functional response during drug-induced sleep endoscopy: a proof-of-concept study","volume":"30","author":"Harkins","year":"2026","journal-title":"Sleep Breath"},{"issue":"4","key":"2026091518062282700_ref16","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1213\/ANE.0000000000000229","article-title":"Safety and efficacy of drug-induced sleep endoscopy using a probability ramp propofol infusion system in patients with severe obstructive sleep apnea","volume":"119","author":"Atkins","year":"2014","journal-title":"Anesth Analg"},{"issue":"4","key":"2026091518062282700_ref17","doi-asserted-by":"publisher","first-page":"800","DOI":"10.2307\/2336325","article-title":"A sharper Bonferroni procedure for multiple tests of significance","volume":"75","author":"Hochberg","year":"1988","journal-title":"Biometrika."},{"key":"2026091518062282700_ref18","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","edition":"2"},{"issue":"2","key":"2026091518062282700_ref19","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1007\/s11325-015-1237-4","article-title":"Functional outcome of tongue motions with selective hypoglossal nerve stimulation in patients with obstructive sleep apnea","volume":"20","author":"Heiser","year":"2016","journal-title":"Sleep Breath"},{"issue":"3","key":"2026091518062282700_ref20","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1002\/lary.28779","article-title":"Transoral versus endoscopic examination in predicting outcomes of hypoglossal nerve stimulation for obstructive sleep apnea","volume":"131","author":"Lee","year":"2021","journal-title":"Laryngoscope"},{"issue":"5","key":"2026091518062282700_ref21","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.5664\/jcsm.9852","article-title":"Neurophysiological profiles of responders and nonresponders to hypoglossal nerve stimulation: a single-institution study","volume":"18","author":"Wang","journal-title":"J Clin Sleep Med"},{"issue":"10","key":"2026091518062282700_ref22","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1001\/jamaoto.2024.2559","article-title":"Pharyngeal manometry and upper airway collapse during drug-induced sleep endoscopy","volume":"150","author":"Harkins","year":"2024","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"8","key":"2026091518062282700_ref23","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1001\/jamaoto.2019.1437","article-title":"Obstruction patterns during drug-induced sleep endoscopy vs natural sleep endoscopy in patients with obstructive sleep apnea","volume":"145","author":"Park","year":"2019","journal-title":"JAMA Otolaryngology Head and Neck Surg"},{"key":"2026091518062282700_ref24","doi-asserted-by":"publisher","DOI":"10.21037\/joma-23-36","article-title":"Comparing upper airway awake exploration, drug-induced sleep endoscopy and natural sleep\u2014a systematic review","volume":"3","author":"Matarredona-Quiles","year":"2024","journal-title":"J Oral Maxillofac Anesth"},{"issue":"2","key":"2026091518062282700_ref25","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.otohns.2009.11.002","article-title":"Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls","volume":"142","author":"Rabelo","year":"2010","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"4","key":"2026091518062282700_ref26","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1002\/ohn.880","article-title":"Percutaneous approaches to hypoglossal nerve stimulation: a pilot study during drug-induced sleep endoscopy","volume":"171","author":"Kent","year":"2024","journal-title":"Otolaryngol Head and Neck Surg"},{"issue":"6","key":"2026091518062282700_ref27","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1136\/rapm-2022-104097","article-title":"Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain","volume":"48","author":"Shanthanna","year":"2023","journal-title":"Reg Anesth Pain Med"},{"issue":"5","key":"2026091518062282700_ref28","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1152\/japplphysiol.00091.2012","article-title":"Upper airway collapsibility and patterns of flow limitation at constant end-expiratory lung volume","volume":"113","author":"Owens","year":"2012","journal-title":"J Appl Physiol (1985)"},{"issue":"2","key":"2026091518062282700_ref29","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1152\/japplphysiol.00755.2009","article-title":"The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility","volume":"108","author":"Owens","year":"2010","journal-title":"J Appl Physiol (1985)"}],"container-title":["SLEEP"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsag227\/70786626\/zsag227.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsag227\/70786626\/zsag227.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:06:28Z","timestamp":1789509988000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article\/doi\/10.1093\/sleep\/zsag227\/8770618"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1093\/sleep\/zsag227","relation":{},"ISSN":["0161-8105","1550-9109"],"issn-type":[{"value":"0161-8105","type":"print"},{"value":"1550-9109","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"zsag227"}}