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

Sleep and Breathing volume 24, pages399–411(2020)Cite this article

Abstract

Objective

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).

Methods

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.

Results

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.

Conclusion

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.

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Author information

Affiliations

  1. Unit of Otolaryngology, UOS ORL TI, Campus Bio-Medico University, Rome, Italy

    Andrea Costantino, Vittorio Rinaldi, Vitaliana Luccarelli & Manuele Casale

  2. Unit of Otolaryngology, University of Foggia, Foggia, Italy

    Antonio Moffa & Michele Cassano

  3. Department of Physical and Rehabilitation Medicine, Campus Bio-Medico University, Rome, Italy

    Federica Bressi

  4. Unit of Otolaryngology, Clínica Universidad de Navarra, Pamplona, Spain

    Peter Baptista

Authors
  1. Andrea Costantino
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  2. Vittorio Rinaldi
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  3. Antonio Moffa
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  4. Vitaliana Luccarelli
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  5. Federica Bressi
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Correspondence to Antonio Moffa.

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Costantino, A., Rinaldi, V., Moffa, A. et al. Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis. Sleep Breath 24, 399–411 (2020). https://doi.org/10.1007/s11325-019-01923-2

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Keywords

  • Obstructive sleep apnea
  • Hypoglossal nerve
  • Upper airway
  • Stimulation
  • Long term