Comparative Efficacy of Hypoglossal Nerve Stimulation and Continuous Positive Airway Pressure in Obstructive Sleep...

This systematic review aims to compare the efficacy of hypoglossal nerve stimulation (HNS) versus continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA). A literature search was performed in PubMed and the Cochrane Library using keywords related to HNS, CPAP, and OSA, with a 10-year time limit (2014-2024). Five comparative clinical studies (four retrospective cohort studies and one prospective cohort study) were included. Outcome measures included the apnea-hypopnea index (AHI), mean disease alleviation (MDA), and Epworth Sleepiness Scale (ESS). Both HNS and CPAP significantly reduced AHI from baseline in all included studies (p < 0.001). Between-group differences in AHI reduction were inconsistent across studies. MDA was higher in HNS patients than in CPAP patients in two studies (59% vs. 51%; 22.9% vs. 5.0%). All studies demonstrated statistically significant improvements in ESS scores in both groups; most studies favored HNS, while one study showed a slightly greater improvement with CPAP. Both treatments effectively reduce respiratory events in OSA. Due to high heterogeneity, variable follow-up periods, and non-randomized designs, no definitive conclusion can be drawn that HNS is superior to CPAP. However, HNS is associated with better patient-reported outcomes and higher real-world effectiveness, likely related to superior adherence. HNS represents a valuable alternative for patients who are intolerant to CPAP. Future large-scale randomized controlled trials are required to confirm comparative efficacy.