Joachim T Maurer

Universität Mannheim, Mannheim, Baden-Württemberg, Germany

Are you Joachim T Maurer?

Claim your profile

Publications (151)217.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the efficacy and durability of upper airway stimulation via the hypoglossal nerve on obstructive sleep apnea (OSA) severity including objective and subjective clinical outcome measures.
    Otolaryngology Head and Neck Surgery 09/2014; · 1.73 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Upper-airway stimulation (UAS) using a unilateral implantable neurostimulator for the hypoglossal nerve is an effective therapy for obstructive sleep apnoea patients with continuous positive airway pressure intolerance. This study evaluated stimulation effects on retropalatal and retrolingual dimensions during drug-induced sedation compared with wakefulness to assess mechanistic relationships in response to UAS. Patients with an implanted stimulator underwent nasal video endoscopy while awake and/or during drug-induced sedation in the supine position. The cross-sectional area, anterior–posterior and lateral dimensions of the retropalatal and retrolingual regions were measured during baseline and stimulation. 15 patients underwent endoscopy while awake and 12 underwent drug-induced sedation endoscopy. Increased levels of stimulation were associated with increased area of both the retropalatal and retrolingual regions. During wakefulness, a therapeutic level of stimulation increased the retropalatal area by 56.4% (p50.002) and retrolingual area by 184.1% (p50.006). During stimulation, the retropalatal area enlarged in the anterior–posterior dimension while retrolingual area enlarged in both anterior–posterior and lateral dimensions. During drug-induced sedation endoscopy, the same stimulation increased the retropalatal area by 180.0% (p50.002) and retrolingual area by 130.1% (p50.008). Therapy responders had larger retropalatal enlargement with stimulation than nonresponders. UAS increases both the retropalatal and retrolingual areas. This multilevel enlargement may explain reductions of the apnoea–hypopnoea index in selected patients receiving this therapy.
    European Respiratory Journal 09/2014; · 6.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. Methods The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. Results A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows.Otherwise, no consensus has been reached on a scoring and classification system. Conclusions Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking
    Sleep And Breathing 05/2014; · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Obstructive sleep apnea is associated with considerable health risks. Although continuous positive airway pressure (CPAP) can mitigate these risks, effectiveness can be reduced by inadequate adherence to treatment. We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea. METHODS Using a multicenter, prospective, single-group, cohort design, we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy. The primary outcome measures were the apnea–hypopnea index (AHI; the number of apnea or hypopnea events per hour, with a score of ≥15 indicating moderate-to-severe apnea) and the oxygen desaturation index (ODI; the number of times per hour of sleep that the blood oxygen level drops by ≥4 percentage points from baseline). Secondary outcome measures were the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire (FOSQ), and the percentage of sleep time with the oxygen saturation less than 90%. Consecutive participants with a response were included in a randomized, controlled therapy-withdrawal trial. RESULTS The study included 126 participants; 83% were men. The mean age was 54.5 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 28.4. The median AHI score at 12 months decreased 68%, from 29.3 events per hour to 9.0 events per hour (P<0.001); the ODI score decreased 70%, from 25.4 events per hour to 7.4 events per hour (P<0.001). Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life. In the randomized phase, the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group (8.9 and 7.2 events per hour, respectively); the AHI score was significantly higher (indicating more severe apnea) among the 23 participants in the therapy-withdrawal group (25.8 vs. 7.6 events per hour, P<0.001). The ODI results followed a similar pattern. The rate of procedure-related serious adverse events was less than 2%. CONCLUSIONS In this uncontrolled cohort study, upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea. (Funded by Inspire Medical Systems; STAR ClinicalTrials.gov number, NCT01161420.)
    New England Journal of Medicine 01/2014; 370:139-49. · 54.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The treatment of diseases of the lingual tonsils is still under debate, and surgical interventions are often associated with significant morbidity and complications. The aim of the present study was to evaluate the safety of lingual tonsillectomy using cold ablation (coblation) as a new treatment of lingual tonsil diseases. In this retrospective, bicentric study, we included all patients between 2005 and 2012 who underwent cold ablation (Coblation(®)) of the lingual tonsils. We assessed the frequency of postoperative complications based on the patients' charts. A total of 108 patients (47 ± 13, 6 years) underwent lingual tonsillectomy using coblation. All patients were operated on under general anesthesia as inpatients. Intraoperative complications did not occur. Three patients (2.8 %) needed revision surgery due to postoperative hemorrhage, and in one of those cases, three revisions were necessary. There was no postoperative airway compromise and no need for tracheostomy. There was no hypoglossal nerve paralysis, but in the case needing multiple revisions, a weakness of the hypoglossal nerve persisted. In all the cases, oral intake was possible with adequate analgesia. Coblation of the tongue base is a safe procedure with a relatively low rate of postoperative complications. Postoperative hemorrhage is the most relevant complication that occurred in our series of patients. Future studies are needed to evaluate the efficacy of the procedure in the treatment of obstructive sleep apnea.
    Archives of Oto-Rhino-Laryngology 01/2014; · 1.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: These guidelines aim to facilitate high quality medical care of adults with snoring problems. The guidelines were devised for application in both in- and outpatient environments and are directed primarily at all those concerned with the diagnosis and therapy of snoring. According to the AWMF three-level concept, these represent S2k guidelines.A satisfactory definition of snoring does not currently exist. Snoring is the result of vibration of soft tissue structures in narrow regions of the upper airway during breathing while asleep. Ultimately, these vibrations are caused by the sleep-associated decrease in muscle tone in the area of the upper airway dilator muscles. A multitude of risk factors for snoring have been described and its occurrence is multifactorial. Data relating to the frequency of snoring vary widely, depending on the way in which the data are collected. Snoring is usually observed in middle-aged individuals and affected males predominate. Clinical diagnosis of snoring should comprise a free evaluation of the patient's medical history. Where possible this should also involve their bed partner and the case history can be complimented by questionnaires. To determine the airflow relevant structures, a clinical examination of the nose should be performed. This examination may also include nasal endoscopy. Examination of the oropharynx is particularly important and should be performed. The larynx and the hypopharynx should be examined. The size of the tongue and the condition of the mucous membranes should be recorded as part of the oral cavity examination, as should the results of a dental assessment. Facial skeleton morphology should be assessed for orientation purposes. Technical examinations may be advisable in individual cases. In the instance of suspected sleep-related breathing disorders, relevant comorbidities or where treatment for snoring has been requested, an objective sleep medicine examination should be performed. Snoring is not-at least as we currently understand it-a disease associated with a medical threat; therefore there is currently no medical necessity to treat the condition. All overweight patients with snoring problems should strive to lose weight. If snoring is associated with the supine position, positional therapy can be considered. Some cases of snoring can be appropriately treated using an intraoral device. Selected minimally invasive surgical procedures on the soft palate can be recommended to treat snoring, provided that examinations have revealed a suitable anatomy. The choice of technique is determined primarily by the individual anatomy. At an appropriate interval after the commencement or completion a therapeutic measure, a follow-up examination should be conducted to assess the success of the therapy and to aid in the planning of any further treatments.
    HNO 11/2013; 61(11):944-57. · 0.42 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: patients undergoing UAS therapy, a large interindividual differ-ence in response to stimulation is obser ved. 13,14 A recent study by Van de Heyning et al. examined a set of factors predictive for therapy response to UAS. 13 Study Objectives: To study the possible predictive value of drug-induced sleep endoscopy (DISE) in assessing therapeu-tic response to implanted upper airway stimulation (UAS) for obstructive sleep apnea (OSA). Methods: During DISE, artifi cial sleep is induced by midazol-am and/or propofol, and the pharyngeal collapse patterns are visualized using a fl exible fi beroptic nasopharyngoscope. The level (palate, oropharynx, tongue base, hypopharynx/epiglot-tis), the direction (anteroposterior, concentric, lateral), and the degree of collapse (none, partial, or complete) were scored in a standard fashion. Results: We report on the correlation between DISE results and therapy response in 21 OSA patients (apnea-hypopnea index [AHI] 38.5 ± 11.8/h; body mass index [BMI] 28 ± 2 kg/m², age 55 ± 11 y, 20 male/1 female) who underwent DISE before implantation of a UAS system. Statistical analysis revealed a signifi cantly better outcome with UAS in patients (n = 16) without palatal complete concentric collapse (CCC), reducing AHI from 37.6 ± 11.4/h at baseline to 11.1 ± 12.0/h with UAS (p < 0.001). No statistical difference was noted in AHI or BMI at baseline between the patients with and without palatal CCC. In addition, no predictive value was found for the other DISE collapse patterns documented. Conclusions: The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy. DISE can be recommended as a patient selection tool for implanted UAS to treat OSA. de Vries N; Van de Heyning PH. Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 2013;9(5):433-438. http://dx.doi.org/10.5664/jcsm.2658
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 05/2013; 9(5):433-8. · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To study the possible predictive value of drug-induced sleep endoscopy (DISE) in assessing therapeutic response to implanted upper airway stimulation (UAS) for obstructive sleep apnea (OSA). During DISE, artificial sleep is induced by midazolam and/or propofol, and the pharyngeal collapse patterns are visualized using a flexible fiberoptic nasopharyngoscope. The level (palate, oropharynx, tongue base, hypopharynx/epiglottis), the direction (anteroposterior, concentric, lateral), and the degree of collapse (none, partial, or complete) were scored in a standard fashion. We report on the correlation between DISE results and therapy response in 21 OSA patients (apnea-hypopnea index [AHI] 38.5 ± 11.8/h; body mass index [BMI] 28 ± 2 kg/m(2), age 55 ± 11 y, 20 male/1 female) who underwent DISE before implantation of a UAS system. Statistical analysis revealed a significantly better outcome with UAS in patients (n = 16) without palatal complete concentric collapse (CCC), reducing AHI from 37.6 ± 11.4/h at baseline to 11.1 ± 12.0/h with UAS (p < 0.001). No statistical difference was noted in AHI or BMI at baseline between the patients with and without palatal CCC. In addition, no predictive value was found for the other DISE collapse patterns documented. The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy. DISE can be recommended as a patient selection tool for implanted UAS to treat OSA. Vanderveken OM; Maurer JT; Hohenhorst W; Ha-mans E; Lin HS; Vroegop AV; Anders C; de Vries N; Van de Heyning PH. Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 2013;9(5):433-438.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2013; 9(5):433-438. · 2.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The low success rates for current surgical treatments for obstructive sleep apnea highlight the need for new methods for treating the disorder. This manuscript describes the novel Inspire upper airway stimulation method that through stimulation of the hypoglossal nerve leads to concomitant contraction of the innervated tongue protrusor musculature and increased airway patency. Three components, a stimulating electrode lead, an implantable pulse generator, and a respiration sensing lead, are surgically implanted at 3 separate sites. Detailed descriptions of the surgical method and accompanying illustrations clarify the procedure. Finally, the protocols for activating and titrating the system are detailed. Preliminary clinical investigations on carefully selected patients suggest that the Inspire Upper Airway Stimulation system is an efficacious therapy for treating obstructive sleep apnea.
    Operative Techniques in Otolaryngology-Head and Neck Surgery 09/2012; 23(3):227–233.
  • Source
    Joachim T Maurer
    Sleep And Breathing 07/2012; · 2.26 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: The need for surgical treatment alternatives for obstructive sleep apnea is unchanged. However, recommendations regarding these treatments can often only be given with caution as there are only a limited number of controlled studies available. To perform controlled trials and even more so placebo controlled trials in the field of sleep surgery is challenging, especially in comparison to studies evaluating conservative approaches. Nevertheless, these studies can be carried out also in the field of sleep surgery. In this review we present recent concepts and high-quality surgical trials with innovative study designs. A Medline search revealed 310 studies regarding surgical treatment of sleep apnea. These studies were assessed regarding quality, execution and number of subjects. A total of 12 randomized controlled studies were identified addressing palatal implants, radio-frequency surgery, nasal surgery, maxillomandibular advancement and laser-assisted uvulopalatoplasty (LAUP). Furthermore this review addresses the limitations of surgical studies and the differences compared to trials dealing with conservative approaches. The studies presented in this review demonstrate that high-quality trials regarding surgical treatment of obstructive sleep apnea are feasible and can lead to recommendations with high evidence levels.
    HNO 04/2012; 60(4):294-9. · 0.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous feasibility studies have shown that electrical stimulation of the hypoglossal nerve can improve obstructive sleep apnea (OSA). The current study examined the safety and preliminary effectiveness of a second generation device, the Upper Airway Stimulation (UAS) system, and identified baseline predictors for therapy success. Two consecutive open prospective studies. UAS systems were implanted in patients with moderate to severe OSA who failed or were intolerant of continuous positive airway pressure (CPAP). The study was conducted in 2 parts. In part 1, patients were enrolled with broad selection criteria. Apnea hypopnea index (AHI) was collected using laboratory-based polysomnography at preimplant and postimplant visits. Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ) were also collected. In part 2, patients were enrolled using selection criteria derived from the experience in part 1. In part 1, 20 of 22 enrolled patients (two exited the study) were examined for factors predictive of therapy response. Responders had both a body mass index ≤32 and AHI ≤50 (P < .05) and did not have complete concentric palatal collapse. Part 2 patients (n = 8) were selected using responder criteria and showed an improvement on AHI from baseline, from 38.9 ± 9.8 to 10.0 ± 11.0 (P < .01) at 6 months postimplant. Both ESS and FOSQ improved significantly in part 1 and 2 subjects. The current study has demonstrated that therapy with upper airway stimulation is safe and efficacious in a select group of patients with moderate to severe OSA who cannot or will not use CPAP as primary treatment.
    The Laryngoscope 03/2012; 122(7):1626-33. · 1.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: Success rates of non-ventilation therapies for sleep disordered breathing (SDB) remain hardly acceptable. Drug-induced sleep endoscopy (DISE) tends to show the level and mechanism of obstruction and helps to specify therapy individually. Therefore, increasing success rates are expected. The objective of this study is to detect whether locations of treatment recommendations given after DISE are different to those made after clinical basic ENT (ear, nose, throat) examination (CBE). METHODS: This study included patients with obstructive sleep apnea (OSA) and primary snoring who wish or require an alternative therapy to the gold standard, continuous positive airway pressure (CPAP). After CBE, a theoretical treatment recommendation was given comprising surgery (possible surgical target: soft palate, tonsils, tongue base, epiglottis) and mandibular advancement splints (MAS) or both. A second ENT specialist conducted a DISE and independently recommended a second therapy concept without knowing the first one. A third person compared both theoretical locations of treatment recommendations (CBE vs. DISE). RESULTS: A total of 97 patients (eight female and 89 male, age 30-85 years, AHI 1.9-88.6/h, body mass index [BMI] 20.3-36.3 kg/m²) received two therapy recommendations. Regarding surgical options only, 63.9% of the examined patients got a different recommendation in at least one of four levels. If MAS was included, a change was found in 78.4% of the patients. Subdivided into each type of intervention, the following changes were found in the therapy concept: 24.7% (n = 24/97) soft palate, 12.4% (n = 12/97) tonsils, 33.0% (n = 32/97) tongue base, 27.8% (n = 27/97) epiglottis, 38.1% (n = 37/97) MAS. CONCLUSIONS: DISE shows a relevant influence on the location of treatment recommendation. Thus, a change in success rates of non-CPAP therapy in OSA and snoring appears possible.
    Sleep And Breathing 01/2012; · 2.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Palatal implants have been used to treat snoring and mild to moderate obstructive sleep apnea (OSA). Two previous controlled trials have published conflicting results regarding the effects of palatal implants on objective outcome measures, although they both could demonstrate superiority over placebo. The aim of the present study was to assess the effects of palatal implants in patients with mild to moderate sleep apnea in a randomised, placebo-controlled trial. Twenty-two patients with mild to moderate OSA (AHI 18 ± 5, BMI 28 ± 3, age 51 ± 13 years) due to palatal obstruction were enrolled in this randomised, double-blind, placebo-controlled trial. Respiratory parameters and sleep efficiency (evaluated by polysomnography), snoring (evaluated by the bed partner), and daytime sleepiness (evaluated by ESS) were assessed before and 90 days after surgery. One patient in each group did not show up for follow-up. The AHI, HI and LSAT showed statistically significant improvement in the treatment group (p < 0.05). Snoring as rated by bed partners also showed statistically significant improvement within the treatment group (p = 0.025). There was no statistical difference when comparing the means of the treatment group with the placebo group. There were no peri- or post-operative complications and no extrusions during the follow-up period. The study supports the idea that palatal implants lead to a reduction in respiratory events in patients with mild to moderate OSA, although a statistically significant superiority of palatal implants over placebo could not be demonstrated in this trial.
    Archives of Oto-Rhino-Laryngology 01/2012; 269(7):1851-6. · 1.29 Impact Factor
  • Source
    Joachim T Maurer
    Sleep And Breathing 12/2011; 15(4):623. · 2.26 Impact Factor
  • Source
    Joachim T Maurer
    Sleep And Breathing 09/2011; · 2.26 Impact Factor
  • Boris A Stuck, Sarah Leitzbach, Joachim T Maurer
    [Show abstract] [Hide abstract]
    ABSTRACT: Although continuous positive airway pressure (CPAP) is the gold standard in the treatment of obstructive sleep apnea (OSA), its effectiveness depends on the regular use. In this retrospective study, the effectiveness of CPAP with regard to the reduction of the apnea-hypopnea index was calculated based on individual adherence data extracted from a cohort of patients with OSA METHODS: The electronic database was analyzed for follow-up visits of patients receiving CPAP for OSA. The following information was extracted the charts of 750 patients: apnea-hypopnea index (AHI) at diagnosis, AHI with CPAP, duration of therapy, hours of CPAP use, and subjective hours of sleep. Eighty-two successfully treated and stable CPAP patients (AHI/Epworth Sleepiness Scale (ESS) at baseline 35.6 ± 22.1/10.5 ± 5.1) could be further evaluated. Mean AHI under CPAP was 2.4 ± 2.5 with an ESS of 6.9 ± 4.2. Subjective hours of sleep were 6.5 ± 1.1. The average treatment period was 584.6 ± 566.5 days (3,800 h of sleep). Mean hours of use was 2,712 ± 3,234 (4.69 ± 2.42 per night). This leads to the following calculated measures: hours of sleep without CPAP, 1,088; number of respiratory events with CPAP, 6508.8; number of respiratory events without CPAP, 38,732.8; total number or respiratory events, 45,241.6; average AHI, 11.91. Even in an ideal group of patients, CPAP cannot eliminate respiratory events due to limited adherence. Adherence needs to be taken into account when comparing the effects of CPAP on the AHI with alternative treatment methods, especially those with 100% adherence (e.g., surgery).
    Sleep And Breathing 05/2011; 16(2):467-71. · 2.26 Impact Factor

Publication Stats

1k Citations
217.82 Total Impact Points

Institutions

  • 1996–2014
    • Universität Mannheim
      Mannheim, Baden-Württemberg, Germany
  • 2010–2013
    • Universitätsmedizin Mannheim
      Mannheim, Baden-Württemberg, Germany
  • 2009
    • Central Institute of Mental Health
      Mannheim, Baden-Württemberg, Germany
  • 2008–2009
    • Asklepios Klinik Harburg
      Hamburg, Hamburg, Germany
  • 2000–2008
    • Universität Heidelberg
      • • Center of Sleep Medicine
      • • Faculty of Medicine Mannheim and Clinic Mannheim
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2007
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
    • Norwegian University of Science and Technology
      Nidaros, Sør-Trøndelag, Norway
  • 2005
    • Universität Regensburg
      • Lehrstuhl für Hals-Nasen-Ohren-Heilkunde
      Regensburg, Bavaria, Germany