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Introduction Complex sleep apnea refers to the emergence of central apnea when obstructive apneas have been adequately treated. While a combination of medications and noninvasive positive airway pressure ventilation is frequently used in patients with this syndrome, the optimal treatment has not yet been fully elucidated. With the advent of nerve stimulation therapy, it is now possible to target specific physiologic mechanisms and provide precise and adjustable therapy. We present a case in which two distinct nerve stimulators were used to successfully treat a patient with complex sleep apnea. Report of Cases: We present a case in which a ptient with complex slepe apnea was successfully treated by implantation of two distinct nerve stimulators: hypoglossal nerve stimulation therapy for obstructive sleep apnea and phrenic nerve stimulation therapy for concomitant central sleep apnea. Conclusion Complex sleep apnea was successfully treated in this patient with the combination of hypoglossal and phrenic nerve stimulation therapy as evidenced by a reduction in both the obstructive and central apnea hypopnea indices. This patient also had significant clinical improvement with decreased excessive daytime sleepiness and improved daytime functioning as evidenced by decreased Epworth Sleepiness Score, improved patient reported daytime activity, decreased apnea hypopnea index, and increased total sleep time. This case provides evidence for the efficacy and safety of the simultaneous use of hypoglossal and phrenic nerve stimulation for the treatment of complex sleep apnea. Is also highlights the importance of obtaining a laboratory polysomnographic evaluation in all patients prior to any sleep device implantation. Further study is needed, however, to establish the long-term efficacy of this approach to treatment. Support (If Any) I am seeking financial support and assistance for meeting attendance and travel for the June sleep meeting from Inspire Sleep Apnea and other travel assistance funds.

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Introduction Patient compliance to continuous positive airway pressure (CPAP) has been about 50% at 4-years despite numerous improvements in mask design, flow algorithms, education, and monitoring software. Compliance, however, is not equivalent to efficacy. Upper Airway Stimulation (UAS) is an alternative for select CPAP intolerant patients. We used a patient management platform to track UAS compliance and efficacy. Methods Anonymized, aggregated device usage and outcomes data was analyzed from a HIPAA compliant patient management platform (Inspire Cloud, Inspire Medical Systems, Golden Valley MN) through October 2021. Demographic data is not collected. We used this database to understand therapy outcomes. Data are presented as mean and standard deviation, unless otherwise noted. Results There were 1.74 million usage nights for 5,709 patients across 550 clinics. Patients increased median stimulation amplitude from 1.4 to 2.2 volts between activation to 90 days after activation. Typical therapy was activated at 11:44pm, and turned off at 5:51am, with one 13-minute pause per night, and therapy was on 89% of nights.Usage was 5.5 ± 1.8 hours per nights overall, and 6.0 ± 1.9 hours per night used. At 90 days, 90% of patients had usage > 4 hours per nights overall, and 96% had usage > 4 hours per night used.Average pre-implant AHI was reduced from 35 ± 15 events/hour (n=2760), to 9 ± 12 (n=1609) after therapy. ESS was reduced from 11 ± 5 (n=1254) to 7 ± 5 (n=1164). Conclusion This data represents the first big-data reporting of UAS therapy usage in general clinical practice including nightly data. It demonstrates high nightly usage with minimal pauses and marked improvement in symptoms. It demonstrates the potential that CPAP intolerant patients with can be fully adherent with alternative therapy. Support (If Any) Statistical support provided by Inspire Medical systems.