Body Mass Index and Hypoglossal Nerve Stimulation Outcomes: A Systematic Review and Meta-Analysis

Area of Science:

• Otolaryngology
• Sleep Medicine
• Surgical Outcomes Research

Background:

• Obstructive sleep apnea (OSA) is a common sleep disorder.
• Hypoglossal nerve stimulation (HGNS) is an effective treatment for OSA.
• The impact of body mass index (BMI) on HGNS outcomes requires further investigation.

Purpose of the Study:

• To systematically review and meta-analyze the influence of BMI on surgical outcomes of HGNS for OSA.
• To compare HGNS outcomes in patients with BMI ≥ 32 kg/m² versus BMI < 32 kg/m².

Main Methods:

• Systematic review and meta-analysis following PRISMA guidelines.
• Searched PubMed, Embase, and Scopus for relevant studies (January 2014 - April 2025).
• Extracted data on study design, demographics, baseline AHI, and postoperative outcomes; assessed study quality using the Newcastle-Ottawa Scale.

Main Results:

• Seven studies (n=1572) were included; four underwent meta-analysis.
• Pooled odds ratio for treatment success in BMI ≥ 32 kg/m² vs. < 32 kg/m² was 0.87 (95% CI: 0.68-1.11).
• Low between-study heterogeneity (I²=27%) indicated consistent effect estimates.

Conclusions:

• Elevated BMI showed a nonsignificant trend toward lower HGNS success rates.
• Many patients with BMI ≥ 32 kg/m² achieved significant improvements.
• Findings challenge rigid BMI-based eligibility criteria, supporting individualized candidacy assessment for HGNS.