Clinical Outcomes of Hypoglossal Nerve Stimulation Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea

Objectives Obstructive sleep apnea (OSA) is linked to cardiovascular, metabolic, and neuropsychiatric morbidity. Continuous positive airway pressure (CPAP) remains first‐line therapy, but poor adherence limits effectiveness. Hypoglossal nerve stimulation (HNS) is an emerging alternative for CPAP‐intolerant patients. This study compared clinical outcomes between HNS and CPAP in OSA patients. Study Design Retrospective Cohort Study. Setting TriNetX Research Network. Methods We identified adults with OSA who underwent HNS implantation or initiated CPAP therapy, with 2 years of follow‐up. Propensity score matching (n = 3525 per group) balanced baseline demographics and comorbidities. Acute cardiovascular, respiratory, and metabolic outcomes were assessed from 30 days posttreatment to 2 years. A similar analysis was performed to compare health outcomes of HNS and uvulopalatopharyngoplasty (UPPP) surgery without future CPAP use. Results The HNS cohort had significantly lower odds of stroke (odds ratio [OR] 0.626, P = .0085), myocardial infarction (OR 0.612, P < .0108), atrial fibrillation/flutter (OR 0.594, P < .0001), hypertensive crisis (OR 0.456, P < .0274), pulmonary embolism (OR 0.209, P < .0001), ventricular tachycardia (OR 0.349, P = .0001), COPD exacerbation (OR 0.270, P < .0001), acute kidney injury (OR 0.283, P < .0001), ED visit (OR 0.457, P < .0001), hospitalization (OR 0.419, P < .0001), acute heart failure (OR 0.198, P < .0001), heart failure exacerbation (OR 0.221, P < .0001), acute respiratory failure (OR 0.172, P < .0001), and pneumonia (OR 0.255, P < .0001). Daytime sleepiness was more common in the HNS group (OR 2.019, P < .0001). HNS and UPPP cohorts displayed largely similar health outcomes. Conclusion HNS may offer systemic benefits and reduce healthcare burden compared to CPAP. Future studies should incorporate adherence data and cost‐effective analyses to guide treatment.