Outcomes of Hypoglossal Nerve Stimulator Implant in Obstructive Sleep Apnea Patients With Various Health Statuses

Hypoglossal nerve stimulation (HGNS) is increasingly used in the management of moderate-to-severe obstructive sleep apnea (OSA). In this study, we investigated whether common medical and psychiatric comorbidities are associated with apnea-hypopnea index (AHI) reduction and treatment success after HGNS implantation.

Charts of patients who underwent HGNS implantation with pre-operative AHI of 65 or below were reviewed. ANOVA, linear mixed-effects model (LMM), and multivariate logistic regression analyses on AHI and demographics and medical comorbidities were performed on RStudio. Outcomes for logistic analysis pertained to whether they met the Sher20 criteria for treatment success.

A total of 204 patients were included, of whom 174 were male and 30 were female. At the nominal 0.05 threshold, obesity was associated with higher AHI across time in the ANOVA analysis (F = 7.539, p = 0.0066) and with lower odds of Sher20 treatment success at 6 months (OR = 0.31, 95% CI: 0.10-0.90). In the small CAD subgroup (n = 16), CAD was associated with a lower longitudinal percent reduction in AHI in the linear mixed-effects model (β = -31.88, p = 0.033). No other modeled covariates met the nominal significance threshold.

Obesity and CAD emerged as potential, rather than established, predictors of less favorable HGNS response. These findings are exploratory and require validation, particularly the CAD association, which was based on only 16 patients and arose in the setting of multiple unadjusted comparisons.

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