Abstract Introduction Obstructive sleep apnea affects millions worldwide, with continuous positive airway pressure (CPAP) remaining first-line therapy despite persistent adherence challenges. Hypoglossal nerve stimulation (HGNS) offers an alternative for appropriately selected patients. This study compares treatment adherence and Median Disease Alleviation (MDA) between CPAP and HGNS in the same patient cohort using multiple AHI thresholds and timepoints. Methods This retrospective cohort study (2016-2024) examined 45 patients with moderate-severe OSA initially treated with CPAP who later transitioned to HGNS. Patients served as internal controls. CPAP adherence data from ResMed Airview and HGNS adherence from SleepSync were collected at 30-day and 90-day timepoints. Median Disease Alleviation was calculated using target AHI thresholds of both 3 and 4 events/hour for each therapy. Adherence and efficacy were compared using paired t-tests. Results The cohort (n=45) was predominantly male (71.1%), White (77.7%) and non-Hispanic (88.8%). The mean age was 58.2 years (SD 10.4), the mean BMI was 28.8 kg/m2 (SD 3.01) and the mean baseline AHI was 42.8 events/hour (SD 15.6). CPAP adherence at 30 days was 56.3% compared to 93.1% for HGNS (p 0.001). At 90 days, CPAP adherence remained 55.8% while HGNS adherence was 91.7% (p 0.001). Using a 4% AHI threshold, median disease alleviation was 52.7% for CPAP versus 87.6% for HGNS. With a 3% AHI threshold, median MDA was 54.1% for CPAP versus 89.2% for HGNS. Statistical analysis demonstrated significantly superior HGNS adherence at both timepoints with large effect sizes (Cohen's d 1.0). Conclusion These findings demonstrate that HGNS therapy achieves approximately 65% greater median disease alleviation than CPAP, primarily through dramatically improved adherence sustained over 90 days. The substantial compliance advantage of HGNS translates to enhanced real-world therapeutic benefit regardless of AHI threshold used. Superior adherence may improve long-term cardiovascular and quality-of-life outcomes. Further prospective studies examining long-term efficacy and patient-reported outcomes are warranted. Support (if any)
Buenrostro et al. (Fri,) studied this question.