Selective upper airway stimulation in patients with moderate and severe obstructive sleep apnea

Question Hypoglossal nerve stimulation (HGNS) is an efficient surgical treatment of obstructive sleep apnea (OSA) in patients unable to tolerate positive airway (PAP) pressure. It is applied to both, patients suffering from moderate OSA and severe OSA. This study aims to examine potential differences in patients’ outcome.

Methods A consecutive cohort of 128 patients with moderate to severe sleep apnea was included, who underwent hypoglossal nerve stimulation implantation surgery between 2014 and 2020. Patients were divided into two groups: patients of group 1 (n=48) suffered from moderate OSA (AHI < 30/h), patients of group 2 (n=79 patients) from severe OSA (AHI >=30/h). We provide data regarding BMI, age and sex. All patients underwent baseline polysomnography (PSG) prior to surgery and were controlled by PSG or home sleep study on 2, 6 and 12 months after implantation. Epworth Sleepiness Scale (ESS) and therapy adherence have been examined as therapy endpoints.

Results All subjects showed a stable reduction of daytime sleepiness, similar in both groups (p=0,6). Among the subjects with moderate sleep apnea, a median of 11±4,6 ESS points prior to implantation was reduced to 6±3,8 ESS points after one year. In the severe group a preoperative median of 10±5,5 points was reduced to a median of 7±4,4 points by HGNS. Therapy was used 6,1±2,5 hours per night (median) in moderate cases and 5,0±2,5 hours per night (median) in severe cases after 12 months.

Conclusion Selective upper airway stimulation is a highly effective therapeutic approach for moderate and severe obstructive sleep apnea. During a one year follow-up ESS was reduced effectively and durably in both groups. This study contributes to identify preoperative clinical parameters of improved therapy outcome.

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Publication History

Article published online:
13 May 2021