0591 Improving Efficiency & Patient Outcomes Using Longitudinal Monitoring via a HSAT with Hypoglossal Nerve Stimulation

Abstract Introduction Hypoglossal Nerve Stimulation (HGNS) is an increasingly prevalent treatment for moderate-severe obstructive sleep apnea (OSA). HGNS therapy requires titration to identify the optimal stimulation parameters for patient comfort and OSA improvement. The recommended post-activation care protocol is long, typically taking 90-120 days to complete. The purpose of this study was to evaluate an optimized protocol utilizing a home sleep apnea test (HSAT) capable of long-term longitudinal monitoring to frequently assess treatment efficacy as stimulation amplitude adjustments were being made. Methods The study included 30 adults undergoing titration of an HGNS implant at a Sleep Clinic in Arizona, USA from January-October 2023. The revised protocol: The device was activated 3-weeks post-op and the stimulation amplitude was increased by 0.1V every 4 days following device activation. Patients were advised to test their sleep with a HSAT for 1 night on the 2nd night after every amplitude increase to minimize the risk of “1st night effect” after the initial amplitude increase. Follow-up visits were scheduled every 2 weeks post-activation, where the HSAT data was reviewed. Apnea/Hypopnea Index (AHI) and SPO2 were used to evaluate OSA severity. An in-lab titrations study was conducted 10-12 weeks post-activation if the patient was asymptomatic and adherent, and the HSAT showed significant improvement in OSA parameters. Results The updated care protocol took an average of 63.76 (SD 41.14) days from activation to completion 86.6% (n=26) of patients completed the program in 90 days and 60% (n=18) completed the program in ≤60 days. The mean percent reduction in AHI was 68.09% (SD 21.89; mean -15.21 AHI). The mean increase in minimum SPO2 was 4.31% (SD 5.11). Conclusion A new HGNS titration protocol that included frequent testing with a HSAT allowed for objective, longitudinal assessment of the effectiveness of each amplitude/output adjustment. Monitoring OSA parameters minimized over-titration of the device amplitude, improving patient comfort, and allowed for earlier identification of the need to try a different electrode configuration if the AHI was not improving. This study demonstrated that a shorter program length was possible while still maintaining good treatment efficacy. Support (if any) Employees of Wesper contributed to the data analysis.