(1310) Efficacy of Hypoglossal Nerve Stimulator in Patients With Independent Epiglottic Collapse

Introduction: For patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure (CPAP), hypoglossal nerve stimulator (HGNS) implantation is a highly effective treatment. During evaluation for implant candidacy, drug induced sleep endoscopy (DISE) occasionally reveals patients with epiglottic collapse independent of tongue base collapse. As the device primarily works by stimulating protrusion of the tongue, there has been debate over the efficacy of the implantation in patients with this collapse variant. This retrospective chart review was performed to determine if HGSN was equivalently effective in the management of OSA in patients with tongue dependent epiglottic collapse and those with independent epiglottic collapse.

Methods: The charts of 197 adult patients treated for OSA with HGNS between November 2015 through July 2023 were reviewed. Patients were evaluated based on their BMI at time of HGNS insertion, DISE epiglottic evaluation, gender, BMI, tobacco use, original apnea hypopnea index (AHI), and efficacy of their implantation in the management of OSA. Efficacy of implantation was defined as reduction of AHI from moderate or severe to mild in their first postoperative polysomnogram. Statistical analysis of patient data was performed using R Version 4.3.1.

Results: Our study identified 41 patients with tongue base dependent epiglottic collapse and 27 with independent collapse. The overall success rate of HGNS insertion for this cohort was 82.8%. Tested alone and when accounting for BMI, sex, and smoking status through multivariable regression analysis, there was no difference between success of the HGNS in those with tongue base dependent epiglottic collapse (90.2%) or independent collapse (81.5%)(p = 0.41). Similar to other studies, it was noted that for each unit increase in BMI, the odds of success from implantation were reduced by 16% (OR 0.84, 95% CI 0.71-0.97, p = 0.027).

Conclusions: Patients with independent epiglottic collapse receive equivalent benefit from HGNS implantation as those with tongue base dependent epiglottic collapse.