LAUSR

The use of hypoglossal nerve stimulation (HGNS) for treatment of obstructive sleep apnea (OSA) has been reported to be efficacious in up to 75% of patients with a 68% improvement in the 3% apnea hypopnea index (AHI). Based on these results, HGNS is an increasingly widespread alternative treatment for OSA patients who are intolerant of Positive Airway Pressure (PAP) treatment. It is unknown if HGNS is equally efficacious outside of the highly controlled setting of a clinical trial. Here, we performed a retrospective cohort study from patients who underwent implantation of a hypoglossal nerve stimulator at our academic institution and report the efficacy based on improvement in AHI. Adult subjects with a diagnosis of OSA, who were intolerant of PAP therapy and underwent implantation of HGNS at Barnes Jewish Hospital in St. Louis, Missouri from 6/4/2019 to 6/28/2022 were included in this retrospective cohort study. Only those who were referred for implantation from Washington University Sleep Medicine Center were included. The efficacy of HGNS was evaluated by comparing the 3% AHI on subjects’ polysomnography before and after the HGNS was implanted and activated. Analysis of the data was done using paired t-tests to determine efficacy of HGNS via a reduction of at least 50% of the 3% AHI and a reduction in 3% AHI to less than 20 events per hour. 45 subjects were implanted of which 1 subject did not tolerate HGNS, and 8 subjects were lost to follow-up. Of the remaining 36 subjects, the median 3% AHI decreased 79% from 29.5 to 6.5 events per hour (p< 0.0001). There was a reduction of at least 50% of the 3% AHI in 83% of subjects and a reduction of 3% AHI to less than 20 events per hour in 86% of subjects. HGNS achieved significant therapeutic results in the majority of patients with OSA who are intolerant of PAP therapy. These results add to the growing body of evidence reproducing the original clinical trial in a “real-world” setting free of any conflict of interest. Future studies examining predictive factors influencing the effectiveness of HGNS are needed.