Using Postactivation Adjustment as a Marker for Inferior Outcomes in Hypoglossal Nerve Stimulator Patients

This study aimed to examine differences in postoperative outcomes between patients requiring postactivation adjustment and those who do not, within a cohort of patients undergoing hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea (OSA).

Retrospective database analysis.

Single-institution, academic center.

We reviewed patients undergoing HGNS placement for OSA from January 2020 to December 2021. Adjustment visits were defined as any visit that occurred after the initial activation of the device but before postoperative sleep study, including modification of the HGNS device settings (stimulation voltage, configuration, pulse width, rate, start, and pause delay). Primary outcome measures included postoperative apnea-hypopnea index (AHI) and O₂ nadir collected via a sleep study. Secondary aims included identifying significant predictors of needing postactivation adjustment.

Of 116 patients undergoing HGNS placement, 30 (25.6%) required postactivation adjustment. These patients had a higher average postoperative AHI of 21.3, compared to 12.5 in those who did not undergo adjustments (P = .002). Additionally, adjustment patients had a significantly lower postoperative O₂ nadir (82% vs 85%; P = .009). A higher baseline body mass index was observed in patients requiring adjustments (29.4 vs 28.3; P = .047). Decreasing sleep latency and increasing total VOTE score on drug-induced sleep endoscopy were significant predictors of needing postactivation adjustment (P = .046, .014).

Patients experiencing early postactivation HGNS intolerance, requiring device adjustment, have significantly poorer long-term surgical sleep outcomes for OSA. Early identification of this cohort is crucial to optimizing treatment for those less responsive to HGNS therapy.