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Published on: December 6, 2016
Clinical Outcomes of Hypoglossal Nerve Stimulation Versus Continuous Positive Airway Pressure in Obstructive Sleep
Amala Nayak1, Iman Adibi1, Alyssa Calder1
1Department of Otolaryngology-Head and Neck Surgery Virginia Commonwealth University School of Medicine Richmond PO BOX Virginia USA.
Objectives:
Obstructive sleep apnea (OSA) is linked to cardiovascular, metabolic, and neuropsychiatric morbidity. Continuous positive airway pressure (CPAP) remains first-line therapy, but poor adherence limits effectiveness. Hypoglossal nerve stimulation (HNS) is an emerging alternative for CPAP-intolerant patients. This study compared clinical outcomes between HNS and CPAP in OSA patients.
Study Design:
Retrospective Cohort Study.
Setting:
TriNetX Research Network.
Methods:
We identified adults with OSA who underwent HNS implantation or initiated CPAP therapy, with 2 years of follow-up. Propensity score matching (n = 3525 per group) balanced baseline demographics and comorbidities. Acute cardiovascular, respiratory, and metabolic outcomes were assessed from 30 days posttreatment to 2 years. A similar analysis was performed to compare health outcomes of HNS and uvulopalatopharyngoplasty (UPPP) surgery without future CPAP use.
Results:
The HNS cohort had significantly lower odds of stroke (odds ratio [OR] 0.626, P = .0085), myocardial infarction (OR 0.612, P < .0108), atrial fibrillation/flutter (OR 0.594, P < .0001), hypertensive crisis (OR 0.456, P < .0274), pulmonary embolism (OR 0.209, P < .0001), ventricular tachycardia (OR 0.349, P = .0001), COPD exacerbation (OR 0.270, P < .0001), acute kidney injury (OR 0.283, P < .0001), ED visit (OR 0.457, P < .0001), hospitalization (OR 0.419, P < .0001), acute heart failure (OR 0.198, P < .0001), heart failure exacerbation (OR 0.221, P < .0001), acute respiratory failure (OR 0.172, P < .0001), and pneumonia (OR 0.255, P < .0001). Daytime sleepiness was more common in the HNS group (OR 2.019, P < .0001). HNS and UPPP cohorts displayed largely similar health outcomes.
Conclusion:
HNS may offer systemic benefits and reduce healthcare burden compared to CPAP. Future studies should incorporate adherence data and cost-effective analyses to guide treatment.
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