OBJECTIVE: To identify predictors of patient decision to pursue sleep apnea surgery following initial consultation with a sleep surgeon. STUDY DESIGN: Retrospective cohort analysis. SETTING: Outpatient tertiary care academic center. METHODS: A retrospective review of patients with obstructive sleep apnea (OSA) diagnosis, BMI < 35 kg/m², and prior positive airway pressure (PAP) trial who were evaluated at a sleep surgery clinic. Patients who completed drug-induced sleep endoscopy (DISE) and/or surgery were compared to those who did not within at least 4 months of consultation. Surveys on OSA-related symptoms and decisional conflict were completed prior to the consultation for PAP alternatives. RESULTS: Among 437 patients, 321 did not undergo DISE/surgery, whereas 116 completed DISE/surgery within an average of 16.8 months of consultation. Patients who underwent DISE/surgery had a significantly higher Epworth sleepiness scale score (10.1 ± 4.9 vs 8.5 ± 5.1, P = .006) and insomnia severity index (15.6 ± 5.5 vs 14.3 ± 5.8, P = .037) as well as significantly lower decisional conflict scale (DCS) scores (27.9 ± 21.8 vs 38.2 ± 24.9, P < .001). Multivariate analysis revealed that lower preconsultation DCS score (OR = 0.97, 95% CI [0.97, 0.99], P < .001) and lower BMI (OR = 0.91, 95% CI [0.85, 0.99], P = .019) were independently significant predictors of pursuing DISE/surgery. CONCLUSION: Decisional conflict prior to consultation is significantly associated with completion of DISE/surgery. Those with higher decisional conflict are less likely to proceed with DISE/surgery after consultation on PAP alternatives. Effective interventions that improve patient understanding of OSA and enhance support in decision-making are needed.

Cancer immunotherapy with autologous chimeric antigen receptor (CAR) T cells faces challenges in manufacturing and patient selection that could be avoided by using off-the-shelf products, such as allogeneic CAR natural killer T (AlloCAR-NKT) cells. Previously, we reported a system for differentiating human hematopoietic stem and progenitor cells into AlloCAR-NKT cells, but the use of three-dimensional culture and xenogeneic feeders precluded its clinical application. Here we describe a clinically guided method to differentiate and expand IL-15-enhanced AlloCAR-NKT cells with high yield and purity. We generated AlloCAR-NKT cells targeting seven cancers and, in a multiple myeloma model, demonstrated their antitumor efficacy, expansion and persistence. The cells also selectively depleted immunosuppressive cells in the tumor microenviroment and antagonized tumor immune evasion via triple targeting of CAR, TCR and NK receptors. They exhibited a stable hypoimmunogenic phenotype associated with epigenetic and signaling regulation and did not induce detectable graft versus host disease or cytokine release syndrome. These properties of AlloCAR-NKT cells support their potential for clinical translation.