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Study Objectives: We evaluated the quality of ChatGPT responses to questions on obstructive sleep apnea for patient education and assessed how prompting the chatbot influences correctness, estimated grade level, and references of answers. Methods: ChatGPT was queried 4 times with 24 identical questions. Queries differed by initial prompting: no prompting, patient-friendly prompting, physician-level prompting, and prompting for statistics/references. Answers were scored on a hierarchical scale: incorrect, partially correct, correct, correct with either statistic or referenced citation (“correct+”), or correct with both a statistic and citation (“perfect”). Flesch–Kincaid grade level and citation publication years were recorded for answers. Proportions of responses at incremental score thresholds were compared by prompt type using chi-squared analysis. The relationship between prompt type and grade level was assessed using analysis of variance. Results: Across all prompts (n = 96 questions), 69 answers (71.9%) were at least correct. Proportions of responses that were at least partially correct ( P = .387) or correct ( P = .453) did not differ by prompt; responses that were at least correct+ ( P < .001) or perfect ( P < .001) did. Statistics/references prompting provided 74/77 (96.1%) references. Responses from patient-friendly prompting had a lower mean grade level (12.45 ± 2.32) than no prompting (14.15 ± 1.59), physician-level prompting (14.27 ± 2.09), and statistics/references prompting (15.00 ± 2.26) ( P < .0001). Conclusions: ChatGPT overall provides appropriate answers to most questions on obstructive sleep apnea regardless of prompting. While prompting decreases response grade level, all responses remained above accepted recommendations for presenting medical information to patients. Given ChatGPT’s rapid implementation, sleep experts may seek to further scrutinize its medical literacy and utility for patients. Citation: Campbell DJ, Estephan LE, Mastrolonardo EV, Amin DR, Huntley CT, Boon MS. Evaluating ChatGPT responses on obstructive sleep apnea for patient education. J Clin Sleep Med . 2023;19(12):1989–1995.

Study Objectives: Hypoglossal nerve stimulation (HGNS) has been widely used to treat obstructive sleep apnea in selected patients. Here we evaluate rates of revision and explant related to HGNS implantation and assess types of adverse events contributing to revision and explant. Methods: Postmarket surveillance data for HGNS implanted between January 1, 2018 and March 31, 2022, were collected. Event rates and risk were calculated using the postmarket surveillance event counts and sales volume over the same period. Indications were categorized for analysis. Descriptive statistics were reported and freedom from explant or revision curves were grouped by year of implantation. Results: Of the 20,881 HGNS implants assessed, rates of explant and revision within the first year were 0.723% and 1.542%, respectively. The most common indication for explant was infection (0.378%) and for revision was surgical correction (0.680%). Of the 5,820 devices with 3-year postimplantation data, the rate of explant was 2.680% and of revision was 3.557%. During this same interval, elective removal (1.478%) was the most common indication, and for revisions, surgical correction (1.134%). Conclusions: The efficacy of HGNS is comparable in the real world setting to published clinical trial data. Rates of explant and revision are low, supporting a satisfactory safety profile for this technology. Citation: Moroco AE, Wei Z, Byrd I, et al. Device-related outcomes following hypoglossal nerve stimulator implantation. J Clin Sleep Med . 2024;20(9):1497–1503.

Hypoglossal nerve stimulation in the US requires drug-induced sleep endoscopy to exclude patients with complete concentric collapse. This is an expensive and time-consuming requirement. We hypothesized that supine pharyngeal width, and other demographic and polysomnographic variables would associate with complete concentric collapse. Prospective, multicenter cohort study. 10 centers in the United States with experience selecting patients for and performing airway surgeries for sleep apnea including hypoglossal nerve stimulation implantation. 600 patients meeting criteria for hypoglossal nerve stimulation underwent measurement of supine pharyngeal width and collection of demographic and polysomnographic data followed by drug-induced sleep endoscopy. 587 patients completed the study. Patients with complete concentric collapse had a higher body mass index (31.2 ± 3.2 vs 29.0 ± 3.4 kg/m ,  < .001), larger neck circumference (45.5 ± 4.2 vs 40.6 ± 4.7 cm,  < .001), and lower supine pharyngeal width (19.4 ± 6.3 vs 21.8 ± 6.5 mm;  = .008) than patients without complete concentric collapse. Body mass index, neck circumference, and supine pharyngeal width all associate with complete concentric collapse and could potentially be used to determine hypoglossal nerve stimulation candidacy instead of drug-induced sleep endoscopy for most patients thereby reducing both time and cost. (ClinicalTrials.gov NCT05428839: https://clinicaltrials.gov/study/NCT05428839?term=Inspire%20Medical%20systems%20predictor&rank=1).

Objective To discuss the virtual management options and strategies learned during the COVID‐19 pandemic for treatment of patients with sleep complaints and sleep disordered breathing presenting to the otolaryngologist. Methods/Results The addition of a virtual evaluation can be beneficial in assessing the patient presenting to the otolaryngologist with sleep complaints. With the implementation of telemedicine, validated subjective assessment tools, and a limited physical exam, patients can be triaged for the need for treatment implementation, further evaluation or testing, and counseled regarding various management options. In this article, we discuss the lessons learned from the authors' collective experience on how to effectively use telemedicine as a tool in the management repertoire for patients with sleep disorders. Conclusion The otolaryngologist will commonly see patients with sleep complaints, particularly patients diagnosed with obstructive sleep apnea not able to tolerate conservative therapies. These patients are well suited for virtual evaluation utilizing telemedicine. The technology and workflows which have been developed during the COVID‐19 pandemic can be carried forward for select patients to improve access and efficiency of care. Level of evidence: 5.

Study Objectives: Data from patients at Thomas Jefferson University Hospital (TJUH) and University of Pittsburgh Medical Center (UPMC) undergoing upper airway stimulation (UAS) were analyzed. We hypothesize that treatment with UAS will improve both subjective and objective outcome measures and results will be reproducible between institutions. Methods: We reviewed patients undergoing UAS between May 2014 and August 2016. We recorded demographic data, Epworth Sleepiness Scale (ESS), and preoperative and postoperative polysomnographic information. We compared outcome data between institutions and subsequently combined the cohorts and compared baseline to posttreatment results. Results: The TJUH cohort consisted of 30 males and 18 females with a mean age of 60.88 years and body mass index of 29.29. The mean preoperative apnea-hypopnea index (AHI), O 2 nadir, and ESS were 35.88, 80.96, and 11.09, respectively. The mean postoperative AHI, O 2 nadir, and ESS were 6.34, 88.04, and 5.77, respectively. The UPMC cohort consisted of 30 males and 19 females with a mean age of 62.84 years and body mass index of 27.74. The mean preoperative AHI, O 2 nadir, and ESS were 35.29, 79.58, and 10.94, respectively. The mean postoperative AHI, O 2 nadir, and ESS were 6.28, 84.35, and 6.60, respectively. We found no difference in patients reaching a postoperative AHI less than 15, 10, and 5 when comparing the cohorts. After combining cohorts, we found a significant improvement in postoperative AHI, O 2 nadir, and ESS compared to preoperative values. Conclusions: UAS appears to provide a viable alternative to continuous positive airway pressure, producing improvement in both polysomnographic and quality-of-life measures. Results are reproducible at high-volume centers. Citation: Huntley C, Kaffenberger T, Doghramji K, Soose R, Boon M. Upper airway stimulation for treatment of obstructive sleep apnea: an evaluation and comparison of outcomes at two academic centers. J Clin Sleep Med. 2017;13(9):1075–1079.

Study Objectives We evaluated the accuracy of ChatGPT in addressing insomnia-related queries for patient education and assessed ChatGPT’s ability to provide varied responses based on differing prompting scenarios. Methods Four identical sets of 20 insomnia-related queries were posed to ChatGPT. Each set differed by the context in which ChatGPT was prompted: no prompt, patient-centered, physician-centered, and with references and statistics. Responses were reviewed by 2 academic sleep surgeons, 1 academic sleep medicine physician, and 2 sleep medicine fellows across 4 domains: clinical accuracy, prompt adherence, referencing, and statistical precision, using a binary grading system. Flesch–Kincaid grade-level scores were calculated to estimate the grade level of the responses, with statistical differences between prompts analyzed via analysis of variance and Tukey’s test. Interrater reliability was calculated using Fleiss’s kappa. Results The study revealed significant variations in the Flesch–Kincaid grade-level scores across 4 prompts: unprompted (13.2 ± 2.2), patient-centered (8.1 ± 1.9), physician-centered (15.4 ± 2.8), and with references and statistics (17.3 ± 2.3, P < .001). Despite poor Fleiss kappa scores, indicating low interrater reliability for clinical accuracy and relevance, all evaluators agreed that the majority of ChatGPT’s responses were clinically accurate, with the highest variability on Form 4. The responses were also uniformly relevant to the given prompts (100% agreement). Eighty percent of the references ChatGPT cited were verified as both real and relevant, and only 25% of cited statistics were corroborated within referenced articles. Conclusions ChatGPT can be used to generate clinically accurate responses to insomnia-related inquiries.

A 75-year-old man with body mass index of 30.5 kg/m 2 and severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) of 72 events/h was referred for upper airway stimulation (UAS) therapy. Past medical history was significant for cardiovascular disease including congestive heart failure due to ischemic cardiomyopathy with impaired left ventricular function and ejection fraction of 35%. Following evaluation of clinical and polysomnographic data, he was an appropriate candidate for UAS and underwent uncomplicated implantation. Three months postoperatively, polysomnography showed a titrated AHI of 0 events/h. Follow-up cardiac evaluation revealed ejection fraction increase to 47% since implantation. No interval change in medical management or body mass index had occurred. Given the high prevalence of OSA in patients with cardiovascular disease, UAS may become an important adjunct in the comprehensive multidisciplinary treatment of heart failure in patients with OSA. Further clinical studies are required to investigate the impact of UAS on treatment and prognosis of heart disease. Citation: Rokkas S, Huntley C, Boon M. Hypoglossal nerve stimulation impact on a patient with obstructive sleep apnea and heart failure. J Clin Sleep Med . 2021;17(5):1125–1127.

Background Obstructive sleep apnea (OSA) is a commonly seen comorbidity in patients undergoing endoscopic skull base surgery and its presence may influence perioperative decision-making. Current practice patterns for preoperative screening of OSA are poorly understood. Objective The objective of this study was to assess how endoscopic skull base surgeons screen for OSA, and how knowledge of OSA affects perioperative decision-making. Methods Seven question survey distributed to members of the North American Skull Base Society. Results Eighty-eight responses (10% response rate) were received. 60% of respondents were from academic centers who personally performed >50 cases per year. Most respondents noted that preoperative knowledge of OSA and its severity affected postoperative care and increased their concern for complications. Half of respondents noted that preoperative knowledge of OSA and its severity affects intraoperative skull base reconstruction decision-making. 70% of respondents did not have a preoperative OSA screening protocol. Body mass index and patient history were most frequently used by those who screened. Validated screening questionnaires were rarely used. 76% of respondents agreed or somewhat agreed that a preoperative polysomnogram should ideally be performed for patients with suspected OSA; however, 50% of respondents reported that <20% of their patients with suspected OSA are advised to obtain a preoperative polysomnogram. Conclusion This study reveals that most endoscopic skull base surgeons agree that OSA affects postoperative patient care, but only a minority have a preoperative screening protocol in place. Additional study is needed to assess the most appropriate screening methods and protocols for OSA patients undergoing endoscopic skull base surgery.

Introduction Proton pump inhibitors (PPIs) are widely used for gastroesophageal reflux disease (GERD) despite possible side effects including increased susceptibility to infections, secondary hypergastrinemia, and incomplete absorption of micronutrients. Upper airway stimulation (UAS) surgery involves delivering an electrical impulse to the distal hypoglossal nerve for the management of obstructive sleep apnea.. The functional threshold (FT) is the minimum stimulation required to achieve bulk tongue motion. The minimum therapeutic amplitude (MTA) is the lowest voltage required to achieve clinical benefit during titration at postoperative attended overnight polysomnography. We sought to analyze the effect of perioperative PPI use upon patients who had undergone upper airway stimulation (UAS) surgery. We hypothesized that the ion transport-related effects of PPIs would impact the amplitude necessary for tongue protrusion (FT) and clinical benefit (MTA). Methods A retrospective chart review was conducted at a single tertiary care facility. Baseline demographic data, medication history, and comorbidities were collected from December 2014 through August 2019 on patients undergoing UAS surgery. Patients that were taking a PPI at the time of surgery and postoperatively were included. Results 167 patients that underwent UAS surgery between 2014 – 2019 were studied. 74 patients were found to be taking a PPI perioperatively. Specifically, 38 patients were found to be on omeprazole, compared to 17 on pantoprazole, 13 on esomeprazole, 4 on lansoprazole, and 2 on rabeprazole. Overall, esomeprazole was a statistically significant predictor (p=0.0359) of a lower functional threshold amplitude: 1.58 mV in controls as compared to 2.09 mV for omeprazole, 2.12 mV for pantoprazole, 2.14 mV for lansoprazole, and 2.7 mV for rabeprazole. Use of PPI, while associated with lower FT voltage, was not a predictor of statistically significant changes in initial UAS minimum therapeutic amplitude settings. Conclusion The functional threshold amplitude for patients taking esomeprazole was significantly different compared to patients not on a PPI. However, the use of PPI overall was not a statistically significant predictor of initial difference in UAS mean therapeutic amplitude settings. Future studies examining tolerance of therapy and voltage changes over time in patients on proton-pump inhibitors are needed. Support (if any):