0545 Hypoglossal Nerve Stimulation: Does Higher Pre-Implantation PAP Pressure Result in Less Successful Outcomes?

Abstract Introduction Despite hypoglossal nerve stimulation (HNS) being an approved therapy for moderate to severe OSA, some patient’s do not have a favorable outcome despite meeting the inclusion criteria for the procedure. This study investigates whether higher pre-implantation optimal PAP pressure results in less successful HNS outcomes. Methods This is a single-center retrospective study of consecutive patients with moderate to severe OSA who underwent implantation of HNS at an academic medical center. The optimal pre-implantation pressure setting was derived from either PAP titration studies (optimal CPAP or EPAP pressure) or PAP therapy compliance reports (90th or 95th percentile CPAP pressure or 95th percentile EPAP pressure). Pre-implantation AHI was obtained from either a home sleep study or diagnostic sleep study. Post-implantation apnea/hypopnea index (AHI) was derived from polysomnography performed 3 months or later after device activation in all subjects. Success of HNS therapy was defined as either a reduction of the pre-implantation AHI by equal to or greater than 50% or a residual AHI 15. A Mann-Whitney nonparametric test was used to compare the distribution of pre-implantation PAP pressure between successful and unsuccessful HNS therapy. Results Fifty-one patients with HNS implanted between December 2021 and July 2023 were evaluated. 74.7% were male with a median age of 65 years (25th percentile 57 and 75th percentile 72) and median body mass index (BMI) of 29.4 (25th percentile 27.2 and 75th percentile 31.6). Median BMI of the HNS success group was 29.4 (n = 45, 25th percentile 27.4 and 75th percentile 31.6) and median BMI of the HNS not success group was 30.0 (n = 6, 25th percentile 26.8 and 75th percentile 33.2). Median pre-implantation optimal PAP pressure of the HNS success group was 11.2 cm H2O (25th percentile 8.7 and 75th percentile 14.25). Median pre- implantation optimal PAP pressure of HNS not success group was 9.2 cm H2O (25th percentile 5.6 and 75th percentile 15.5). There was no significant difference between optimal pre- implantation PAP pressure and HNS outcome (p = 0.3). Conclusion There was no statistically significant difference between optimal pre-implantation PAP pressure and HNS outcome. Support (if any) none