Impact of Postoperative Weight Changes on Hypoglossal Nerve Stimulation Success for Obstructive Sleep Apnea

Obesity is a well-established risk factor for obstructive sleep apnea (OSA), and weight loss is often recommended alongside hypoglossal nerve stimulation (HGNS) in continuous positive airway pressure-intolerant patients. Our study assesses how long-term changes in body mass index (BMI) following HGNS impact surgical success.

A retrospective case review.

We performed a retrospective case review of OSA patients who underwent HGNS at our institution from 2017 to 2022 and multicenter prospective patient data from the ADHERE registry. Patients were included if they had pre- and postoperative sleep studies and BMI data 1 year following surgery, and postsurgical outcomes were evaluated. Patients were stratified into 3 cohorts based on their BMI change from baseline to final follow-up following surgery: (1) remaining within 2 BMI points, (2) gaining at least 2 BMI points, or (3) losing at least 2 BMI points.

In both institutional cohort (N = 222) and ADHERE cohort (N = 1949), most of the patients remained within 2 BMI points after HGNS (84.1% and 80.8%, respectively). The patients who lost at least 2 BMI points had the greatest reduction in AHI (-24.77 ± 13.84, -22.58 ± 19.76 events/h) compared to patients who maintained stable BMI (-15.10 ± 20.33, -18.85 ± 18.11 events/h) or gained at least 2+ BMI points (-6.39 ± 22.52, -15.82 ± 19.63 events/h) following HGNS (P = .002 and .006, respectively).

While HGNS effectively reduces AHI, this effect was most significant in patients who experienced weight loss compared to those who gained or remained in stable body weight. Our study underscores the importance of postoperative weight management and its adjunctive role in improving HGNS success in OSA patients.