Hypoglossal Nerve Stimulator Implantation in a Non-Academic Setting: Two-Year Result

Upper Airway Stimulation (UAS) is an FDA approved treatment option for patients with moderate-to-severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure (CPAP). Previous studies have shown UAS reduced apnea-hypopnea index (AHI) in controlled clinical trials and from academic institutions. We report patient outcomes and therapy adherence of UAS in a non-academic hospital and clinic setting.

Case series of consecutive patients.

Consecutive implants completed at a community hospital between January 2015 to Feb 2017 are included in this report. All patients underwent baseline polysomnography (PSG) recording and drug-induced sleep endoscopy (DISE) prior to the implant. All patients had returned for standard post-implantation titration PSG at a community sleep clinic to validate and adjust the stimulation setting for optimal response. Results were in mean ± SD, and pre- and post-implant data were compared using a paired student t-test.

A total 22 patients undergoing UAS implant were overweight (BMI of 28.9 ± 5.0 kg/m2) and middle aged (63.2 ± 11.1 years), and had severe OSA (AHI of 35.9 ± 19.1). The AHI from the entire night of the titration study was 16.0 ± 10.4 (P < .01, compared with baseline), and the treatment AHI from the sleep period when the optimal setting was programmed was 1.2 ± 1.1 (P < .001, compared with baseline), and 90% patients had titrated AHI less than 5. The lowest SpO2 increased from 81% ± 8% at baseline to 91% ± 3% at the titrated setting (P = .001). After an average follow up of 95 ± 28.5 days, the therapy use per night was 7.0 ± 1.9 hours per night. The average postoperative ESS was 6.7 ± 5.3 of 18 patients, a reduction from the baseline of 10.9 ± 4.8. A total of 13 of 18 patients with postoperative ESS < 10, a measure indicated normalization of daytime sleepiness.

Patients who elected to receive UAS implant surgery at a non-academic hospital and followed at a sleep clinic showed significant reduction in OSA severity with strong adherence to treatment. These results supported that UAS as a valid treatment option for OSA can be successfully implemented in the non-academic hospital and clinic settings.

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