0596 Comparative Analysis of Continuous Positive Airway Pressure and Hypoglossal Nerve Stimulation

Abstract Introduction Continuous positive airway pressure (CPAP) adherence represents a pervasive, multifactorial challenge. Hypoglossal nerve stimulation (HNS) is an alternative treatment for moderate-severe obstructive sleep apnea (OSA) for those who are CPAP-intolerant. We hypothesized differential predictors of therapy adherence and greater adherence with HNS versus CPAP. Methods We compared adherence and its predictors in patients from the Cleveland Clinic HNS registry (cloud-based data monitoring) versus those on CPAP from the HomePAP study at the 1st and 3rd month timepoints. Linear models assessed age, sex and body mass index (BMI) as 1- and 3-month HNS and CPAP adherence predictors. Propensity score matching (1:1) without replacement and t–tests were used to compare adherence across the groups. Propensity scores were estimated with support vector machine using age, sex, BMI and Epworth Sleepiness Scale (ESS) at baseline. Results We analyzed data from n=63 HNS patients (age:57.9±10.0 years, 60% male, body mass index (BMI):28.8 ±3.3 kg/m2), ESS score:8.83±4.69) and n=126 CPAP patients from the HomePAP study (age:49.8±11.9 years, 63% male, BMI:39.1±9.43 kg/m2, ESS score:14.3±3.8). At 1-month, female sex was associated with increased HNS therapy usage (1.20, SE:0.47, p< 0.01); a finding not observed at 3-months. Propensity score-matched analysis included 28 HNS patients (age: 53.6± 9.9 years, 67% male, BMI:30.7± 2.6 kg/m2, ESS:11.4± 3.7) and 28 CPAP patients (age:58.5± 9.6 years, 85% male, BMI:31.2± 4.0 kg/m2, ESS:12.2± 3.6). At 1-month (HNS n=28, CPAP n=27), usage was 3.90±1.0 hours for CPAP and 6.97±1.09 hours for HNS (p< 0.01). At 3-months (HNS N=27, CPAP N=24), usage was 4.38±1.87 (SD) hours for CPAP and 6.44±1.96 hours for HNS (p< 0.01). Conclusion In this comparative analysis, we identify female sex as a factor associated with early adherence to HNS, findings not observed with CPAP. Using a rigorous approach to address baseline differences, we identify a substantial increased level of adherence in HNS versus CPAP therapy of approximately 2-3 hours which persisted until 3 months. Future investigation should focus on assessing HNS versus CPAP adherence-related improvement in clinical outcomes. Support (if any) NIH grant R21HL170206.