Changes in Wearable Sleep Technology Metrics During Hypoglossal Nerve Stimulation Uptitration

To pilot the use of a wearable consumer sleep technology (CST) for continuous, longitudinal assessment of sleep and cardiac metrics in patients undergoing hypoglossal nerve stimulation (HNS) uptitration for obstructive sleep apnea (OSA).

In this case series, participants implanted at a tertiary care center with HNS used a CST (Oura Ring) nightly, beginning at device activation through uptitration for 4 months. CST outcome metrics included total sleep time (TST), wake time after sleep onset (WASO), average heart rate (AvHR), heart rate variability (HRV), sleep efficiency, and latency. These metrics were evaluated using univariate and multivariate regression models controlling for age, sex, baseline apnea-hypopnea index (AHI), and body mass index (BMI).

Fourteen participants had data on longitudinal HNS use and CST sleep data collected from an average of 106 ± 47 nights per participant (total 1478 nights of data). Higher HNS amplitudes were significantly associated with decreased WASO (p = 0.002), decreased AvHR (p < 0.001), and decreased HRV (p < 0.001). TST increased significantly over time but was not associated with HNS amplitude change. Multivariate analysis of a subgroup showed significant associations between HNS amplitude increases and a decline in WASO (p = 0.047) and reductions in AvHR and HRV (p = 0.044, p = 0.021).

HNS uptitration may be associated with changes in WASO, AvHR, and HRV as tracked longitudinally over 4 months by a wearable CST. HNS uptitration was associated with changes in WASO, AvHR, and HRV. Future studies are needed to understand the effects of HNS therapy on sleep metrics and explore the clinical utility of CST in the paradigm of HNS therapy delivery and outcomes.