Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?
- S-Med
- Oct 14
- 2 min read
Current Food and Drug Administration (FDA) guidelines for surgical management with UAS include adult patients with an AHI between 15 and 65, failure of other treatment modalities, and a BMI less than 32 kg/m2 at the time of surgery. BMI eligibility criteria were initially established by the FDA-approved STAR clinical trial in which patients with a BMI greater than 32 were excluded These recommendations are still routinely followed despite the unknown effectiveness of UAS in patients with a BMI above 32.
The link between OSA and obesity is well known. Mild to moderate obesity is significantly associated with OSA, with an almost 4-fold increase in OSA prevalence with each standard deviation increase in BMI Obesity leads to the collection of adipose tissue around the pharynx and torso that narrows the upper airway through lateral wall collapse. Reduced lung volumes, causing a loss of caudal retraction on the upper airway and increased pharyngeal collapsibility, may also be noted in this population Furthermore, central obesity reduces responsiveness of the upper airway neuromusculature. Each of these findings contributes to OSA pathology.
The present study assessed outcomes In patients exceeding current recommended BMI thresholds for implantation. When comparing patients at varying levels of baseline BMI in our large cohort of patients, there were no significant differences in outcomes reflective of treatment success, supporting prior findings. In contrast to prior studies, the present study tracked BMI longitudinally across treatment time points to better understand patients’ weight trajectories. Interestingly, we found that patients in the BMI cohort, or those starting with a BMI above 32 at baseline, exhibited significant decreases in BMI prior to surgery but rebounded following their procedure. There is often emphasis placed on presurgical BMI given the current UAS criteria, despite studies finding no significant associations with treatment success. Our findings suggest that patients may be incentivized to lose weight to meet UAS criteria, only to return to their initial weight after treatment. Thus, the emphasis on a BMI cutoff may delay treatment for patients with a higher BMI until they meet treatment criteria.
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