Comparison of selective hypoglossal nerve stimulation and positive airway pressure therapy in the treatment of obstructive sleep apnea

Question:

Positive airway pressure (PAP) is the primary therapy for obstructive sleep apnea. Selective hypoglossal nerve stimulation (HNS) is a surgical treatment alternative for obstructive sleep apnea. The aim of this study was to compare both treatment options in patients suffering from moderate-to-severe obstructive sleep apnea.

Patients and Methods:

310 patients with moderate-to-severe sleep apnea (apnea-hypopna-index (AHI) from 15/h to 65/h) were included in this study within the period between 2014 and 2018. Patients were divided into two groups: Group 1 (194 patients) was treated by PAP therapy, whereas group 2 (116 patients) was surgically treated by HNS. We provide data regarding BMI, age and sex for all patients. All patients underwent baseline polysomnography (PSG) prior to the treatment and were controlled by PSG or home sleep study on average 13 months after therapy start.

Results:

Patients of group 1 (PAP therapy) had a mean age of 56 ± 12 years (142 male, 51 female, BMI 30,8 ± 5,8 kg/m2). In group 2 (UAS) the average age was 57 ± 12 Jahre (105 male, 11 female, BMI 29,5 ± 4,0 kg/m2). In group 1 mean AHI was reduced from 34,2 ± 13,5/h initially to 8,0 ± 9,9/h during the titration study and to 9,2/h ± 12,0/h after an average of 14 months. In the second group mean AHI was 36,3 ± 14,8/h prior to UAS implantation and could be decreased to 6,8 ± 14,2/h six months after surgery respectively 8,2 ± 10,4/h 12 months postoperatively (p < 0,01).

Conclusions:

Selective upper airway stimulation is a save and highly effective therapeutic approach for obstructive sleep apnea. On condition that patients are selected carefully, both PAP therapy and UAS can be considered as equivalent treatment options.

Publication History

Publication Date:
23 April 2019 (online)