Evaluating changes in hypoglossal nerve stimulator use over time and long-term adherence

Evaluate patient phenotypes and longitudinal patterns of hypoglossal nerve stimulator (HGNS) use and identify predictors of long-term HGNS adherence.

Patients who underwent HGNS implantation for obstructive sleep apnea (OSA) from 2017 to 2023 and had available data through 9 months post-device activation were included. Adherence rate was defined as percentage of patients using the device for at least 4 h for 70% of nights. Repeated measures ANOVA and Cochran's Q tests were used to analyze changes in HGNS use over time. A k-means clustering analysis was used to identify HGNS user subgroups with shared characteristics and associations with HGNS use.

A total of 59 patients were included, with a mean (SD) age of 62.7 (11.2) years, mean (SD) body mass index of 28.5 kg/m2 (3.2), and an average pre-operative apnea-hypopnea index (AHI) of 38.7 events/hour; the majority were male (78%) and White (98.3%). Patients used their HGNS devices on average for 81.1% of nights (SD 23.5%) and 362 min/night (SD 115), with 0.96 (SD 1.4) pauses/night at 9 months post-activation. The mean percentage of nights and the time/night used decreased significantly over the first 9 months (p < 0.001 for both), while pauses/night increased (p = 0.008). The estimated adherence rate was 52.5% at 9 months. The cluster analysis revealed subgroups with shared characteristics; however, clusters were not associated with HGNS use.

HGNS use appears to decrease over the first nine months after activation. Additional research is warranted to investigate drivers of HGNS use decrement. Given lack of a standardized definition for adherence, future studies should report more granular HGNS use metrics to facilitate comparison across studies.