Impact of the Connected Sleep Remote on Early Adherence to Hypoglossal Nerve Stimulation Therapy

To assess the impact of the connected sleep remote on early adherence to therapy with hypoglossal nerve stimulation therapy.

Prospective cohort study. Objective adherence data was extracted from a cloud-based database on consecutive patients undergoing implantation of unilateral hypoglossal nerve stimulation before and after the introduction of the connected sleep remote.

We identified 121 patients with the original sleep remote and 126 patients with the connected sleep remote in the 12 months before and after the introduction of the connected remote, respectively. Overall usage in the first 7 days was 7.9 h, with therapy used on 95.3% of nights and 0.6 pauses per night. Usage in the first 30 days was 7.7 h, with therapy used on 94.0% of nights and 0.6 h of pause per night. There were no differences between the original and connected sleep remotes at 7, 14, 30, or 60 days. By 90 days, nightly usage was 7.3 h for both groups, but the percentage of nightly usage was higher with the connected remote group at 94.2% compared to the original remote group at 89.2% (p = 0.03). In multivariable analysis, the connected remote was associated with a higher percentage of nightly usage in the first 90 days. There were no differences in early adherence rates between therapy responders and non-responders.

A connected sleep remote allowing remote physician as well as direct patient access to usage data was associated with higher adherence at 90 days, possibly reflecting positive reinforcement provided by the associated smartphone application.