Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea and Comorbid Neuromuscular Disorders

Hypoglossal nerve stimulation (HGNS) is an effective surgical treatment for many patients with moderate-to-severe obstructive sleep apnea (OSA) who are unable to tolerate continuous positive airway pressure. Patients with neuromuscular disorders (NMD) are particularly vulnerable to more complex sleep-related breathing disorders due to respiratory muscle weakness and the associated risk of hypoventilation. In this study, we present five patients with myasthenia gravis (n = 2), muscular dystrophy, Charcot-Marie-Tooth, and advanced multiple sclerosis who underwent HGNS therapy for OSA. At time of surgery, the mean patient age was 54 ± 18.7 years and mean BMI was 24.6 ± 4.6 kg/m². Mean device adherence was 8 ± 1.1 h/night at three months and 7.2 ± 1.7 h/night at 12 months. Mean apnea-hypopnea index (AHI) improved significantly from preoperative baseline (34.9 to 8.5, p = 0.03) and 5/6 patients had a postoperative AHI <5. Epworth Sleepiness Scale scores significantly improved postoperatively (13.1-8.5, p = 0.03). Oxygen nadir trended upward (75.5-85.3, p = 0.84). Our limited findings demonstrate that HGNS was a safe and effective treatment for five patients with OSA and comorbid NMD. Prospective studies and larger sample sizes are warranted to support our findings and confirm whether HGNS is a potential therapeutic option for this unique patient population. Laryngoscope, 135:2631-2633, 2025.