Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis

  • Andrea Costantino
  • Vittorio Rinaldi
  • Antonio MoffaEmail author
  • Vitaliana Luccarelli
  • Federica Bressi
  • Michele Cassano
  • Manuele Casale
  • Peter Baptista
Sleep Breathing Physiology and Disorders • Review



To perform a systematic review and meta-analysis for studies evaluating hypoglossal nerve stimulation (HNS) clinical outcomes in the treatment of moderate to severe obstructive sleep apnea (OSA).


Two authors conducted a literature search to identify prospective studies in PubMed/MEDLINE, Google Scholar, and Cochrane Library databases. The last search was performed on November 17, 2018.


A total of 350 patients (median age 54.3 (IQR 53–56.25) years, BMI 29.8 (IQR 28.8–31.6) kg/m2) from 12 studies were included. The procedure has obtained a surgical success rate of 72.4% (Inspire), 76.9% (ImThera), 55% (Apnex) at 12 months, and 75% (Inspire) at 60-month follow-up. At 12 months, the apnea-hypopnea index (AHI) mean differences was − 17.50 (Inspire; 95% CI: − 20.01 to − 14.98, P < 0.001), − 24.20 (ImThera; 95% CI: − 37.39 to 11.01, P < 0.001), and − 20.10 (Apnex; 95% CI: − 29.62 to − 10.58, P < 0.001). The AHI mean reduction after 5 years was − 18.00 (Inspire, − 22.38 to − 13.62, P < 0.001). The Epworth sleepiness scale (ESS) mean reduction was − 5.27 (Inspire), − 2.90 (ImThera), and − 4.20 (Apnex) at 12 months and − 4.40 (Inspire) at 60 months, respectively. Only 6% of patients reported serious device-related adverse events after 1- and 5-year follow-up.


HNS has obtained a high surgical success rate with reasonable long-term complication rate related to the device implanted. The procedure represents an effective and safe surgical treatment for moderate-severe OSA in selected adult patients who had difficulty accepting or adhering to CPAP treatment.


Obstructive sleep apnea Hypoglossal nerve Upper airway Stimulation Long term 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrea Costantino
    • 1
  • Vittorio Rinaldi
    • 1
  • Antonio Moffa
    • 2
    Email author
  • Vitaliana Luccarelli
    • 1
  • Federica Bressi
    • 3
  • Michele Cassano
    • 2
  • Manuele Casale
    • 1
  • Peter Baptista
    • 4
  1. 1.Unit of Otolaryngology, UOS ORL TICampus Bio-Medico UniversityRomeItaly
  2. 2.Unit of OtolaryngologyUniversity of FoggiaFoggiaItaly
  3. 3.Department of Physical and Rehabilitation MedicineCampus Bio-Medico UniversityRomeItaly
  4. 4.Unit of OtolaryngologyClínica Universidad de NavarraPamplonaSpain

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