Bilateral hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: are patients with fewer apneas less sleepy?

Introduction Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Bilateral hypoglossal nerve stimulation (biHNS) is a therapy alternative for OSA patients with CPAP intolerance. The aim of this study was to investigate whether patients who responded well to therapy were also less sleepy.

Methods Patients who underwent implantation of a biHNS in the Department of Otolaryngology at the Klinikum rechts der Isar of the Technical University of Munich between February 2020 and July 2021 were included. The response of the biHNS was evaluated by the Apnea Hypopnea Index (AHI) and using the Sher criteria (AHI reduction >50% and AHI<20/h) before implantation, 6 months and 12 months after implantation. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS).

Results 6 months, as well as 12 months after implantation of the biHNS, there was a statistically significant reduction in AHI (pre-op median: 37.9/h; M6: 18.1/h, M12: 9.6/h, p<0.05). 6 months after implantation 72.7% of patients showed treatment response according to Sher criteria, 12 months after implantation 77.8%. There was also a significant reduction in ESS (ESS median pre-op: 15 points, M6: 6 points, M12: 9 points). Pre-implantation as well as 6 months and 12 months after implantation there was no statistically significant correlation of AHI with ESS (pre-op p=0.18; M6 p=0.56; M12 p=0.83).

Conclusions After implantation of the biHNS, there was a good response to therapy as well as a reduction in subjective sleepiness. Both pre-operatively and 6 and 12 months after implantation, it was found that patients who had fewer apneas were not subjectively less sleepy.

Publication History

Article published online:
12 May 2023