Sleep Disorders

Hypoglossal Nerve Stimulation vs CPAP and Patient-Reported Outcomes

2015 – 2018

ESS = Epworth Sleepiness Scale, FOSQ = Functional Outcomes of Sleep Questionnaire, ISI = Insomnia Severity Index, PHQ-9 = Patient Health Questionnaire, PROs = patient-reported outcomes

Legend: For FOSQ, improvement is shown by increasing from baseline, while all other PROs report improvement by decrease.

Hypoglossal nerve stimulation (HNS) and positive airway pressure (PAP) have been shown to improve patient-reported outcomes (PROs) in obstructive sleep apnea (OSA). However, there are no data comparing change in PROs between HNS and PAP or on the long-term impact of HNS on comorbid insomnia/depression. This is a retrospective examination using data from 2015–2018 for HNS patients and 2010–2014 for PAP patients, with analyses conducted in 2020. Patients received either HNS (referred sample) or PAP therapy (previous cohort) for OSA. PAP patients were matched to HNS patients based on age, body mass index (BMI), gender, and apnea hypopnea index (AHI). Data collected included AHI for OSA severity, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI), and Patient Health Questionnaire-9 (PHQ-9) for depression indices. Data were collected at baseline and post-therapy follow-up time-points. In 87 HNS patients (aged 62.6 ± 9.5, 69.0% male, 90.8% Caucasian, BMI 28.8 ± 3.1), all PRO changes from baseline to 1-month post-HNS activation showed significant change (ESS 11.53 to 7.88, FOSQ 15.70 to 17.63, ISI 15.13 to 9.17, PHQ-9 8.13 to 4.02; all P < 0.001). Compared with 234 matched PAP patients (aged 62.0 ± 9.7, 73.1% male, 80.2% Caucasian, BMI 29.9 ± 3.4), HNS patients’ depression indices improved more robustly (PHQ-9 least square means and 95% CI: -3.77 [-5.06, -2.47] vs -2.46 [-3.18, -1.73]; mean difference and 95% CI: -1.31 [-2.66, 0.056], P = 0.056), with comparable changes seen in ESS, FOSQ, and ISI scores. Overall, consistent and sustained improvements in PROs were observed 12 months after HNS with comparable success to PAP at 6 months.