Hypoglossal nerve stimulation long-term clinical outcomes: a systematic review and meta-analysis
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.
KeywordsObstructive 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.
This article does not contain any studies with human participants performed by any of the authors.
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