Similar effect of hypoglossal nerve stimulation for obstructive sleep apnea in five disease severity categories

Data on adherence and outcome of Upper Airway Stimulation (UAS) for patients with Obstructive Sleep Apnea (OSA) is collected in an International Registry (ADHERE). Previous publications report significant improvement in self-reported and objective OSA outcomes, durable effectiveness, and high adherence. Debate remains whether the effectiveness of UAS is influenced by pre-operative OSA severity, therefore we aimed to evaluate this, using data from the ADHERE registry.ADHERE is a post-market ongoing international, multicenter registry. Adult patients were included if they had undergone UAS implantation and had at least one follow-up visit recorded in the database on June 8th, 2021. We divided the patients into five subgroups, based on OSA severity at baseline (AHI in events/hour): subgroup 1 (0-15), 2 (15-30), 3 (≥30-50), 4 (>50-65), and 5 (>65). We compared results regarding objective and self-reported treatment outcomes.A total of 1963 patients were included. Twelve months after implantation, there was a significant (p<0.0001) improvement in objective sleep parameters in all subgroups with an AHI above 15 events/hr. Patients in subgroup 1 had the lowest AHI at final visit and the AHI reduction of patients in subgroup 5 was the largest (p<0.0001). No significant difference was found between the subgroups in overall treatment success (66.6%) and improvement of self-reported outcomes.Our results suggest that UAS is an effective treatment for patients with an AHI ≥15 events/hour independent of pre-operative OSA severity. Self-reported outcomes and treatment success did not differ significantly between the five subgroups. These results clearly support that the indication of UAS could be broadened for patients with an AHI above 65 events/hour which to date is not common practice.Registry: ClinicalTrials.gov; Title: Adherence and Outcome of Upper Airway Stimulation (UAS) for OSA International Registry (ADHERE Registry); Identifier: NCT02907398; URL: https://www.clinicaltrials.gov/ct2/show/NCT02907398.