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2024 Stanton Resident Research Award: “Comparative Efficacy of Obstructive Sleep Apnea Patients Undergoing Multilevel Surgery Followed by Upper Airway Stimulation Versus Isolated Upper Airway Stimulation”

Bill Klaproth (Host): This is an AAOMS On the Go podcast. I'm Bill Klaproth. And with me is Dr. Corissa Chang, recipient of the 2024 OMS Foundation Dr. David Stanton Resident Research Award; and Dr. Stanley Liu, he is the senior coauthor on the research article, and they join us to discuss Comparative Efficacy of Obstructive Sleep Apnea Patients Undergoing Multilevel Surgery Followed by Upper Airway Stimulation Versus Isolated Upper Airway Stimulation. Dr. Liu and Dr. Chang, welcome.

Dr. Stanley Liu: Thanks for having us, Bill.

Dr. Corissa Chang: Thank you so much.

Host: Yeah, it's great to see you and congratulations on this great award. That's really something. Very exciting. So Dr. Chang, let me start with you. Obviously, the JOMS editorial board selected your research on this topic. What was your reaction to being honored this way?

Dr. Corissa Chang: Thank you so much, Bill. I'm very honored to have received this award. I was very thrilled when I found out. Receiving the Dr. Stanton Award not only recognizes our team's hard work, but also Dr. Stanton being a legacy in our field and being a distinguished faculty member at the University of Pennsylvania where I'm currently a resident and so lucky to have trained under him. I'm very humbled to receive an award that bears his name. And I really hope to contribute to the specialty in the way that he did.

Host: Well, you already are. And congrats again to both of you. This is quite an accomplishment. And Dr. Liu, what led you and your team to pursue this research topic and what was the development process?

Dr. Stanley Liu: Yeah. So, this was a year when Dr. Corissa Chang was doing a research year with me Stanford University. Stanford's very unique in that so much of Sleep Medicine and Surgery originated from that campus from mentors of our specialty, Dr. Riley and Dr. Powell, and the futures bright with the youngsters. I should note that this is not the first award that Dr. Chang has received from AAOMS. She also previously won a resident research prize for a paper talking about gender differences in sleep apnea care. And just like a lot of chronic conditions, women's health is still under studied and appreciated.

Host: Yeah, that's really exciting, for sure. Well, we're in good hands with people like you, certainly, at the forefront of this and discovering new things. So, thank you for that. And Dr. Chang, did your study's conclusion match your original hypothesis?

Dr. Corissa Chang: Yeah. So, our conclusion did support our original hypothesis. So, our study, 36 patients who underwent hypoglossal nerve stimulation, this was over three years. We put them into two groups. The first one being those who were ineligible initially for hypoglossal nerve stimulation, you know, AHI above 65 events per hour, or concentric collapse of the velum on drug-induced sleep endoscopy; received multi-level surgery MMA, DOME, to name a few, and then underwent the hypoglossal nerve stimulation. And then, the second group received isolated hypoglossal nerve stimulation. And our studies showed that those who received the multi-level surgery followed by the hypoglossal nerve stimulation, that first group had a greater AHI reduction compared to the isolated group. And this is adjusting for age, sex, and BMI.

Host: Dr. Liu, thoughts?

Dr. Stanley Liu: We actually didn't quite know what to expect. I mean, this was kind of a new unchartered territory in that sleep surgery, as we've been promoting it and defining the algorithm, it's on a continuum. So, we understand that procedures have to combine and they have to be on a continuum for treatment success. Though the question was that, you know, the unique combinations of known procedures such as the UPPP and MMA, how does that factor in with DOME and then now the hypoglossal nerve stim? Quite frankly, nobody really had examined this prior to this paper.

Host: So, Dr. Liu, was there anything about the outcomes that you found particularly surprising or noteworthy?

Dr. Stanley Liu: Yeah, I think the most noteworthy aspect is, A, it confirmed that these complementary procedures, they contribute to a good outcome for patients with sleep apnea and that what most of our surgeons already know well you know, the MMA and the UPPP, whether it's in a collaborative fashion with local ENTs who do hypoglossal nerve stimulation or for the OMS surgeons who are also doing the hypoglossal nerve stimulation, they should feel real confident that these complementary procedures have good outcome.

Host: Dr. Chang, any noteworthy things, real wow moments for you?

Dr. Corissa Chang: Yeah. For me, the biggest thing was how significant the reduction was between the two groups. I think my hypothesis was I did predict the first group, the multilevel group would have a good reduction, but was surprised by how big it was, like 18 events per hour between the two groups. And then also, subjectively too, our secondary outcomes included the Epworth scale as well as the fatigue severity scale and that was also more reduced in the first group, the multi-level group.

Host: It's kind of cool when you have those oh-wow moments, like, "Oh, okay. Wow, I didn't expect this. We're learning something here.” Right? Would you say that's true?

Dr. Corissa Chang: Yeah. I mean, as a researcher, it's incredibly exciting to see that after the data analysis comes back.

Host: Yeah. That's awesome. So, I mean, from your work, hopefully we're going to help the OMS treat the public. So, Dr. Liu, how can the average OMS apply these findings to their everyday practice?

Dr. Stanley Liu: One of the simpler ways to describe the findings of this project to patients is, as OMS surgeons, we’re good at building out the structure, you know, building out the house, if you will. But if you really have to power it, and this case, it's the tongue, adding this extra piece to it, again, the results, as Dr. Chang had mentioned, the reduction in AHI is significant and the other aspect that is really key, too, is about accessibility, with some of the exclusion criteria for hypoglossal nerve stimulation. We can address that with the procedures that we already know, we already know how to do as OMS surgeons. And so more patients can benefit from hypoglossal nerve stim. So in terms of accessibility, this is also tremendous for our patients.

Host: Absolutely. You know, sleep apnea affects so many millions of people, so it's got to feel good that you're discovering new ways to help people, I would imagine. And Dr. Chang, I'm just kind of curious, what drew you to a career in oral and maxillofacial surgery? And what are your plans after residency?

Dr. Corissa Chang: Yeah. So I was a dental student at UCSF, University of California, San Francisco, and I attended an event called Passing the Scalpel, and that organization was actually started by my mentor, Dr. Stanley Liu, when he was a chief resident at UCSF.

Host: How about that. I love it.

Dr. Corissa Chang: Yeah. So, that event really kind of opened my eyes to the breadth of the specialty, and I eventually pursued OMFS. And after residency, my goal is to have a dedicated sleep surgery practice, continuing clinical research. That's where my passion lies, and really want to focus on advancing techniques to improve patient outcomes. And I really think a combination of clinical work and academic research will really help patient care and the evolution of our specialty.

Host: People will be in good hands at your practice. I am very confident of that, for sure.

Dr. Corissa Chang: Thank you so much.

Host: Well, this has been great. I want to congratulate you both again. This is really awesome. Before we wrap up, I'd like to get final thoughts on your paper, on winning the award, and really what it means to you. Dr. Liu, let me start with you.

Dr. Stanley Liu: I presume we got the email at the same time, Dr. Chang, and it was a real surprise. I mean, one of those very, very pleasant surprises, of course. I do have to really want to credit the editorial board at JOMS. You know, when we sometimes, and this isn't the first paper where we've had experience, but the editor-in-chief, Dr. Dodson, and team really guided us on how to really communicate our findings in a succinct and effective fashion, which I haven't necessarily found with all journals. And so, I think the journal is doing a great job kind of shepherding the communication from all of our researchers and of our finding. And yeah, that's my thought.

Host: Very well said. Final thoughts from you, Dr. Chang?

Dr. Corissa Chang: Yeah, I'm really glad this highlights our paper. You know, sleep surgery right now is still in its, I believe, infancy compared to other subspecialties in OMFS. And so, I think this really gets people excited about sleep surgery and the innovation.

Host: Absolutely. Well, thank you both for your work in this.

Dr. Stanley Liu: If I can add one comment to that, just one comment to it, because, as you say, because sleep surgery is so new, what is it that we really do? And what I always say is that restoring sleep airway health is the gateway to wellness. You all think about that, because a great day really begins with a great sleep the night before. And if you can't breathe when you're sleeping, we got issues. So, the bar is pretty low, but it's a challenging thing, but the bar is pretty low. So, we want more and more. And OMS surgeons are experts in managing the airway. We're just now asking for your help to help us manage the airway when folks are sleeping.

Host: Yeah. That's a great thought to wrap up on. A great day starts with a great night of sleep. Everybody, let's tweet that out and give you credit Dr. Liu. That's awesome. So, thank you so much. And thank you both for being here today. I appreciate it.

Dr. Stanley Liu: Thank you.

Dr. Corissa Chang: Thank you.

Host: Yeah. Once again, that is Dr. Corissa Chang and Dr. Stanley Liu. For more information, please visit AAOMS.org/JOMS, and that's J-O-M-S. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.