Two vs. Three Incisions for Hypoglossal Nerve Stimulator Implantation to Treat Sleep Apnea: A Systematic Review

Obstructive sleep apnea (OSA) is common among adults in the United States. Hypoglossal nerve stimulation (HNS) is a novel surgical alternative for OSA patients who are nonadherent to first-line treatments. Our systematic review evaluated the surgical and device outcomes of the traditional three-incision versus the newer, less-invasive two-incision HNS implantation technique. Four studies were included based on the inclusion and exclusion criteria. Two studies demonstrated a significant reduction in operative time from three-incision to two-incision (128.7 to 86.6 minutes and 143.3 to 129.4 minutes, respectively). Two studies reported better sleep waveform quality and non-inferior sleep quality index scores, and one study showed fewer follow-up corrective surgeries with the two-incision group (0% vs. 5.4%; p=0.048). Across most studies, postoperative complications were low. The sleep quality improved with both techniques without statistical significance. Based on limited evidence from observational studies, the two-incision approach shortened operative time and had fewer corrective follow-up surgeries without compromising sleep quality relative to the three-incision technique.