Hypoglossal Nerve Stimulator Implantation in a Non-Academic Setting: Two-Year Result

Abstract

Objectives/Hypothesis: Upper Airway Stimulation (UAS) is an FDA approved treatment option for patients with moderate-to-severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure (CPAP). Previous studies have shown UAS reduced apnea-hypopnea index (AHI) in controlled clinical trials and from academic institutions. We report patient outcomes and therapy adherence of UAS in a non-academic hospital and clinic setting. Study Design: Case series of consecutive patients. Methods: Consecutive implants completed at a community hospital between January 2015 to Feb 2017 are included in this report. All patients underwent baseline polysomnography (PSG) recording and drug-induced sleep endoscopy (DISE) prior to the implant. All patients had returned for standard post-implantation titration PSG at a community sleep clinic to validate and adjust the stimulation setting for optimal response. Results were in mean ± SD, and pre- and post-implant data were compared using a paired student t-test. Results: A total 22 patients undergoing UAS implant were overweight (BMI of 28.9 ± 5.0 kg/m2) and middle aged (63.2 ± 11.1 years), and had severe OSA (AHI of 35.9 ± 19.1). The AHI from the entire night of the titration study was 16.0 ± 10.4 (P < 10, a measure indicated normalization of daytime sleepiness. Conclusion: Patients who elected to receive UAS implant surgery at a non-academic hospital and followed at a sleep clinic showed significant reduction in OSA severity with strong adherence to treatment. These results supported that UAS as a valid treatment option for OSA can be successfully implemented in the non-academic hospital and clinic settings. Level of Evidence: 4.