Abstract
Background: This retrospective study aimed to analyze treatment outcomes for patients receiving a hypoglossal nerve stimulation (HNS) device for obstructive sleep apnea (OSA). Methods: Chart reviews were conducted for HNS patients who underwent a post-implantation polysomnography (PSG) (typically performed approximately 2 months after device activation) to assess therapeutic response and optimize stimulation settings. Patients were categorized into “green (GP)” (optimal response: AHI <15, ≥4 hours/night device use, and subjective benefit) and “yellow (YP)” (suboptimal response: failure to meet one or more of these criteria) response pathways. Results: Out of 111 patients assessed, 27 patients met pathway categorization criteria. 12 of those were classified in green and 15 in yellow. Median age and BMI were 63.9 years and 28.7 kg/m², respectively, with a balanced sex assigned at birth distribution. HNS treatment reduced median AHI by 85.6% (from 34.7 to 5.0) for the green pathway (GP), and by 87.4% (from 39.6 to 5.0) for the yellow pathway (YP). Patients who had at least one sleep-related comorbidity were more likely to be in the yellow pathway (p < .001). Comorbidities such as depression and insomnia were significantly associated with suboptimal treatment response (yellow pathway) (p = .003 and p = .02, respectively). Conclusions: This study emphasizes the significance of sleep-related comorbidities as a strong predictor of patient outcomes. More efficient utilization of resources may be achieved by considering comorbid conditions prior to HNS implantation. Given the small sample size and retrospective single-institution design, these findings should be interpreted with caution and may not be generalizable to broader populations.