Abstract Rational:Obstructive sleep apnea (OSA) is linked to Adverse Clinical Outcomes (ACO). Continuous positive airway pressure (CPAP) is the first-line treatment, but adherence is suboptimal. Hypoglossal nerve stimulation (HGNS) is a surgical alternative for some patients. In this study, we compared cerebrocardiovascular outcomes and all-cause mortality in OSA patients treated with HGNS vs CPAP. Methods We retrospectively identified OSA patients treated with HGNS or CPAP in the Veterans Health Administration electronic medical records from 10/1999 to 3/2025 using relevant OSA International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. The CPAP and HGNS groups were matched by sex and race/ethnicity. Two index dates were used: the first diagnosis of OSA (INDEXDX) and the first CPAP prescription or HGNS implantation (INDEXTX). We defined the ACO as the first occurrence of the following events after the INDEXTX: all-cause mortality and/or, hospitalization for atrial fibrillation (AF), congestive heart failure (CHF), acute myocardial infarction (MI), or cerebrovascular accident/transient ischemic attack (CVA/TIA). Descriptive statistics, chi-square, and Cox proportional hazards models were for data analysis. All results are reported with 95% confidence intervals (CIs), and p 0.05. Results We identified 1,771 OSA patients with HGNS implants and matched them to 1,773 patients treated with CPAP. HGNS patients were significantly older (62.10 ± 11.54 vs. 50.89 ± 13.21 years), had higher comorbidity burden (CCI 2: 38.9% vs. 20.2%), longer time from diagnosis to treatment (−2674 vs. −715 days), and lower mean BMI (30.69 vs. 33.66). HGNS was associated with lower all-cause mortality (0.9% vs. 2.4%, p 0.05) and CHF admissions (0.4% vs. 0.7%, p 0.05), but shorter time to first CVA/TIA (233 ± 140.26 vs. 1582 ± 1160.43 days, p 0.05). The Hazard Ratios (HRs) for ACO after adjustment for age and BMI were, 0.60 (95% CI 0.37-0.96) in model1 (without adjustment for interval between INDEXTX and INDEXDX) and 0.45 (95% CI 0.27-0.73, p 0.001) in model 2 (with adjustment for this interval). Conclusions HGNS was associated with a lower risk of adverse clinical outcomes compared with CPAP-treated OSA patients. The results point to possible survival and heart-failure benefits with HGNS, though patient factors such as age, comorbidities, and BMI may influence these findings. Ongoing studies with adherence metrics and longer follow-up are needed to confirm these observations. This abstract is funded by: Supported by National Heart, Lung, and Blood Institute K25 funding (1K25HL152006-01 to J.R.); the Airborne Hazards and Burn Pits Center of Excellence (award FY2024-002 to J.R.); the Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413); the VA Post-Deployment Health Services (now Health Outcomes Military Exposures (HOME)); and VA Merit (award 5I01CX002841-02), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the U.S. government, or Baylor College of Medicine.
Aminnia et al. (2026) studied this question.