Hypoglossal Nerve Stimulation and the Incidence of Cardiovascular Disease

As hypoglossal nerve stimulation (HGNS) grows as an obstructive sleep apnea (OSA) treatment option, health risk reduction data are needed.

To determine whether HGNS is associated with lower incidence of cardiovascular disease (CVD).

This retrospective cohort study was conducted using the Merative MarketScan Commercial Database. Adults undergoing HGNS between 2015 and 2024 were matched to controls meeting HGNS candidacy criteria (ie, diagnosed with OSA, nonadherent to positive airway pressure therapy) who did not undergo implantation.

Patients undergoing HGNS were matched on propensity scores estimated by baseline covariates, years with confirmed OSA, and index visit year. OSA and CVD severity were not available for matching.

For patients without baseline CVD, outcomes were time from index visit to diagnosis of diabetes or hypertension. For patients with baseline diabetes or hypertension, outcomes were time from index visit to diagnosis of a minor or major cardiovascular event. HGNS was modeled with a time-varying covariate because surgery was not expected to affect diagnoses until after 2 years.

The population included 3786 patients who underwent HGNS (median [IQR] age, 53.0 [44.0-59.0] years; 2562 [67.7%] male) and 3395 controls. Among patients without baseline CVD, HGNS (1) was not associated with diabetes diagnosis within 2 years (HR, 1.06; 95% CI, 0.61-1.85) but was associated with lower hazard after 2 years (HR, 0.19; 95% CI, 0.09-0.38), and (2) was associated with higher hazard of hypertension diagnosis within 2 years (HR, 1.70; 95% CI, 1.26-2.28) but lower hazard after 2 years (HR, 0.49; 95% CI, 0.33-0.73). Among patients with baseline diabetes or hypertension, HGNS was associated with higher hazard of a minor (HR, 1.44; 95% CI, 1.06-1.95) or major (HR, 1.62; 95% CI, 1.06-2.48) cardiovascular event diagnosis within 2 years but not associated after 2 years (minor: HR, 0.60; 95% CI, 0.35-1.04; major: HR, 0.65; 95% CI, 0.31-1.36), though the hazards after 2 years began decreasing (minor: HR, 0.42; 95% CI, 0.22-0.79; major: HR, 0.40; 95% CI, 0.17-0.93).

The findings of this cohort study indicate variable but potential longer-term cardiovascular benefits of HGNS and motivate research to verify these associations, explore subgroup differences, and investigate mechanisms underlying potential changes in cardiovascular outcomes after HGNS.