Lenze Nicholas R, Alazawi Dania, Dailey Meghan, Brown Christopher, Hoff Paul T, Goldstein Cathy A
Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48108, USA.
Advanced Research Computing Technology Services, University of Michigan, Ann Arbor, MI, USA.
Sleep Breath. 2025 Jul 18;29(4):249. doi: 10.1007/s11325-025-03415-y.
Evaluate patient phenotypes and longitudinal patterns of hypoglossal nerve stimulator (HGNS) use and identify predictors of long-term HGNS adherence.
Patients who underwent HGNS implantation for obstructive sleep apnea (OSA) from 2017 to 2023 and had available data through 9 months post-device activation were included. Adherence rate was defined as percentage of patients using the device for at least 4 h for 70% of nights. Repeated measures ANOVA and Cochran's Q tests were used to analyze changes in HGNS use over time. A k-means clustering analysis was used to identify HGNS user subgroups with shared characteristics and associations with HGNS use.
A total of 59 patients were included, with a mean (SD) age of 62.7 (11.2) years, mean (SD) body mass index of 28.5 kg/m2 (3.2), and an average pre-operative apnea-hypopnea index (AHI) of 38.7 events/hour; the majority were male (78%) and White (98.3%). Patients used their HGNS devices on average for 81.1% of nights (SD 23.5%) and 362 min/night (SD 115), with 0.96 (SD 1.4) pauses/night at 9 months post-activation. The mean percentage of nights and the time/night used decreased significantly over the first 9 months (p < 0.001 for both), while pauses/night increased (p = 0.008). The estimated adherence rate was 52.5% at 9 months. The cluster analysis revealed subgroups with shared characteristics; however, clusters were not associated with HGNS use.
HGNS use appears to decrease over the first nine months after activation. Additional research is warranted to investigate drivers of HGNS use decrement. Given lack of a standardized definition for adherence, future studies should report more granular HGNS use metrics to facilitate comparison across studies.
评估舌下神经刺激器（HGNS）使用者的患者表型和纵向使用模式，并确定长期HGNS依从性的预测因素。
纳入2017年至2023年因阻塞性睡眠呼吸暂停（OSA）接受HGNS植入且在设备激活后9个月内有可用数据的患者。依从率定义为在70%的夜晚使用设备至少4小时的患者百分比。采用重复测量方差分析和 Cochr an Q检验分析HGNS使用随时间的变化。使用k均值聚类分析来识别具有共同特征以及与HGNS使用相关的HGNS用户亚组。
共纳入59例患者，平均（标准差）年龄为62.7（11.2）岁，平均（标准差）体重指数为28.5 kg/m²（3.2），术前平均呼吸暂停低通气指数（AHI）为38.7次/小时；大多数为男性（78%）和白人（98.3%）。患者平均在81.1%的夜晚（标准差23.5%）使用HGNS设备，每晚使用362分钟（标准差115），激活后9个月时每晚有0.96（标准差1.4）次暂停。在最初的9个月中，每晚使用的平均百分比和每晚使用时间显著下降（两者p均<0.001），而每晚暂停次数增加（p = 0.008）。9个月时估计的依从率为52.5%。聚类分析揭示了具有共同特征的亚组；然而，各亚组与HGNS使用无关。
HGNS使用在激活后的前九个月似乎会减少。有必要进行更多研究以调查HGNS使用减少的驱动因素。鉴于缺乏依从性的标准化定义，未来的研究应报告更详细的HGNS使用指标，以便于跨研究进行比较。
