Hypoglossal Nerve Stimulation Treatment Outcomes in Patients With Supine‐Dependent Obstructive Sleep Apnea

OBJECTIVE: To evaluate hypoglossal nerve stimulation (HGNS) treatment response in patients with supine-dependent obstructive sleep apnea (sOSA) and non-supine-dependent obstructive sleep apnea (nOSA). STUDY DESIGN: Single-institution retrospective cohort study. SETTING: Academic tertiary care medical center. METHODS: A retrospective analysis of 45 unilateral HGNS patients was conducted. Supine, non-supine, and total apnea-hypopnea indices (AHIs) were collected from electronic medical records. Treatment response was assessed with postoperative AHI, change in AHI, and Sher15 and Sher20 criteria (≥50% AHI reduction to ≤15 or ≤20 events per hour, respectively). Mann-Whitney U, chi-squared, and paired t tests were performed in Python. RESULTS: sOSA patients experienced significantly less AHI change (P = .008), though HGNS efficacy was comparable between sOSA and nOSA groups when evaluating outcomes with postoperative AHI and Sher15 (P = 1.0) and Sher20 success (P = .87). HGNS treatment also had similar effects on supine and non-supine AHI. Mean change in supine AHI was -14.51 and mean change in non-supine AHI was -11.17. Mean difference in AHI changes (supine minus non-supine) was -3.34 and not statistically significant (P = .27). CONCLUSION: Unilateral HGNS is a treatment option for both sOSA and nOSA, demonstrating similar overall treatment efficacy with comparable postoperative AHI and surgical success rates in this limited cohort. Larger AHI reductions in nOSA patients may indicate greater therapeutic effect for non-positional obstructive sleep apnea (OSA). Combining HGNS with positional therapy or other strategies to minimize supine sleep time may help enhance outcomes in this subgroup. Further research is needed to explore factors influencing residual AHI in sOSA patients and refine treatment approaches for optimal results.