Hypoglossal Nerve Stimulation in Veterans with Obstructive Sleep Apnea

Abstract

ObjectivesThe hypoglossal nerve stimulator (HNS) is an effective treatment for obstructive sleep apnea (OSA) in a relatively healthy subset of the population. Our aim was to determine the efficacy of HNS in a veteran population with a high incidence of chronic disease and mental health disorders. Our secondary aim was to compare subjective outcomes and adherence between veterans with and without mental health disorders.MethodsWe included all patients who underwent HNS at our institution to date. Veterans were divided into two groups based on whether or not they carried a diagnosis of anxiety, depression, and/or post‐traumatic stress disorder. Demographics, comorbidities, previous OSA treatments, adverse events, and adherence to therapy were recorded. Baseline and treatment outcome data were collected and analyzed including polysomnographic parameters, Epworth sleepiness scale score (ESS), and body mass index.ResultsThirty‐one patients were identified: 93.5% male, median age = 63.0 years. Median apnea hypopnea index (AHI) decreased from 30.0 to 3.0 events/hour (P < .001) and median ESS dropped from 11.0 to 6.5 (P < .001). There was no difference between groups with regard to change in AHI or ESS (P = .31 and .61). Twenty‐six (89.7%) patients achieved surgical success (decrease in AHI > 50% and AHI < 20 events/hour) and 21 (72.4%) had AHI < 5 events/hour. The mean device usage was 5.4 hours/night which was not significantly different between groups (P = .55).ConclusionOur cohort exhibited similar declines in AHI and ESS compared to published studies with adequate adherence to HNS. There were no significant differences in ESS or adherence to therapy between veterans with and without mental health disorders.Level of Evidence4 Laryngoscope, 130:2275–2280, 2020

International Consensus Statement on Obstructive Sleep Apnea

“…In a retrospective case series of 31 Veterans Affairs patients, of whom 61% did not meet the FDA's proposed criteria, Sher's criteria was met in 90%, with 72% achieving an AHI less than 5. 1893 In addition, patients with isolated retropalatal collapse achieve similar results from HNS when compared to patients with other airway collapse patterns. 1894 An analysis of the ADHERE registry found that patients 65 years and older are more likely to have greater AHI reductions and higher device usage.…”

“…Investigation continues into eligibility criteria for HNS since the literature postulates that a wider variety of patients may benefit from HNS than were included in the STAR trial. In a retrospective case series of 31 Veterans Affairs patients, of whom 61% did not meet the FDA's proposed criteria, Sher's criteria was met in 90%, with 72% achieving an AHI less than 5 1893 . In addition, patients with isolated retropalatal collapse achieve similar results from HNS when compared to patients with other airway collapse patterns 1894 .…”

Hypoglossal Nerve Stimulation in Veterans With Comorbid Insomnia and Sleep Apnea

“…It is a highly efficacious treatment modality for improving OSA, even in veterans with mental health comorbidities. [36][37][38][39] Moreover, the device is well tolerated, and a recent meta-analysis revealed a 50% reduction in apnea-hypopnea index (AHI) with usage 86% to 96% of nights at 5.4 to 7.5 hours per night. 37,38 Despite these successes, there is no literature assessing the impact of comorbid insomnia on HNS adherence.…”

“…The hypoglossal nerve stimulator (HNS) was approved by the US Food and Drug Administration (FDA) in 2014 and causes genioglossus muscle contraction and tongue protrusion on inspiration to prevent upper airway obstruction. It is a highly efficacious treatment modality for improving OSA, even in veterans with mental health comorbidities 36–39 . Moreover, the device is well tolerated, and a recent meta‐analysis revealed a 50% reduction in apnea‐hypopnea index (AHI) with usage 86% to 96% of nights at 5.4 to 7.5 hours per night 37 , 38 …”

Induced Hypoglossal Dysfunction as a Cause of Obstructive Sleep Apnea in Mefloquine‐Exposed Veterans

“…I read with interest the recent study by Sarber and colleagues, 1 in which they demonstrated the effectiveness of hypoglossal nerve stimulation in veterans with obstructive sleep apnea. Although strongly limited by sample size, the authors found suggestive evidence of increased effectiveness among veterans with comorbid mental health conditions.…”