Abstract Introduction Hypoglossal nerve stimulation (HGNS) qualification requires a diagnosis of moderate to severe obstructive sleep apnea (OSA), defined by an apnea–hypopnea index (AHI) of 15–100 events per hour. In non-Medicare populations (age 65), candidacy is assessed using single-night home sleep apnea testing (HSAT). However, night-to-night variability can misclassify patients with false negatives whose AHI does not meet the diagnostic threshold on the single night of testing despite meeting HGNS criteria on average. False-negative rates of single-night testing among potential HGNS candidates in this age group were evaluated. Methods We identified 3,469 patients younger than 65 years who completed multi-night HSAT scores using 3% oxygen desaturation criterion. Patients were classified as HGNS candidates if they met the qualifying AHI range of 15–100 on any study night. To estimate the false-negative rate associated with single-night HSAT, we determined the proportion of HGNS-eligible patients whose first night of testing reported an AHI outside the qualifying range. This represents candidates who would have been incorrectly deemed ineligible for HGNS had only a single-night study been performed. Results Of the total 3,469 patients under age 65, 2,174 (62.70%) were found to be HGNS candidates, reporting an AHI from 15-100 on at least one night of testing. Among these candidates, 1,809 (83.21%) achieved a qualifying AHI range on the first night. The remaining 365 candidates (16.79%) did not qualify on their initial study despite meeting the criteria on subsequent nights. These cases represent false negatives that would have been misclassified as ineligible for HGNS under standard single-night testing. On average, these false-negative patients required 3.1 nights of testing before demonstrating an AHI within therapeutic range. Conclusion Single-night HSAT failed to identify 16.79% patients under 65 who ultimately met AHI criteria for HGNS. These findings demonstrate that single-night studies can exclude substantial numbers of individuals who would benefit from HGNS. Multi-night testing may improve the identification of HGNS candidates, ensuring patients with moderate-to-severe OSA who are unable to tolerate CPAP are accurately recognized for therapy. These findings underscore the necessity to re-evaluate single-night HSAT as the standard approach for determining HGNS candidacy. Support (if any)
Jain et al. (Fri,) studied this question.