Hernandez Lidice, Trelles-Garcia Daniela, Medina Michael, Sarna Kaylee, Smolley Laurence, Hadeh Anas
Cleveland Clinic Florida, Weston, FL 33331, USA.
J Clin Med. 2025 Aug 20;14(16):5873. doi: 10.3390/jcm14165873.
: Obstructive sleep apnea (OSA) is a prevalent disorder characterized by airway collapse during sleep. Continuous positive airway pressure (CPAP) is first-line treatment but adherence can decay over time due to intolerance. Hypoglossal nerve stimulation (HNS) has emerged as an alternative, especially for CPAP-intolerant patients. OSA can be classified into position-dependent (PD-OSA) and non-position-dependent (NPD-OSA) subtypes based on apnea-hypopnea index (AHI) variation by sleep posture. : This study aims to evaluate polysomnographic changes following HNS therapy and compare treatment outcomes in PD-OSA and NPD-OSA patients. : A retrospective observational study of 30 patients treated with HNS at a single center between January 2022 and March 2025 was conducted. The primary endpoint was change in overall apnea-hypopnea index (AHI) from baseline to first post-implant in-laboratory polysomnography (PSG). Secondary endpoints included changes in phenotype-specific (supine and non-supine) AHI, Epworth Sleepiness Scale (ESS), and sleep architecture parameters. Subgroup comparisons were performed between PD-OSA and NPD-OSA phenotypes. : Thirty patients (median age 69.5 years; 73% male; median BMI 28.9 kg/m) were included; 27 had sufficient positional data for phenotype classification (66.7% PD-OSA, 33.3% NPD-OSA). Median AHI decreased from 23.5 to 4.8 events/h ( < 0.0001), with reductions in both REM and supine AHI. PD-OSA patients demonstrated the greatest improvement in supine AHI, whereas NPD-OSA patients uniquely improved in non-supine AHI. ESS decreased by a median of 1.5 points overall ( = 0.0015) and met the minimal clinically important difference in NPD-OSA. Sleep architecture showed minimal change, except for a reduction in supine sleep percentage ( = 0.0114). : HNS therapy improved AHI and subjective sleepiness across OSA phenotypes, with distinct positional responses. These findings support the clinical utility of HNS in both PD-OSA and NPD-OSA and suggest phenotype-specific treatment effects warrant further investigation.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，其特征是睡眠期间气道塌陷。持续气道正压通气（CPAP）是一线治疗方法，但由于不耐受，依从性可能会随着时间推移而下降。舌下神经刺激（HNS）已成为一种替代方法，尤其适用于不耐受CPAP的患者。根据睡眠姿势引起的呼吸暂停低通气指数（AHI）变化，OSA可分为体位依赖性（PD-OSA）和非体位依赖性（NPD-OSA）亚型。本研究旨在评估HNS治疗后的多导睡眠图变化，并比较PD-OSA和NPD-OSA患者的治疗效果。对2022年1月至2025年3月期间在单一中心接受HNS治疗的30例患者进行了一项回顾性观察研究。主要终点是从基线到首次植入后实验室多导睡眠图（PSG）时总体呼吸暂停低通气指数（AHI）的变化。次要终点包括特定表型（仰卧位和非仰卧位）AHI、爱泼华嗜睡量表（ESS）和睡眠结构参数的变化。对PD-OSA和NPD-OSA表型进行了亚组比较。纳入了30例患者（中位年龄69.5岁；73%为男性；中位BMI为28.9kg/m）；27例有足够的体位数据用于表型分类（66.7%为PD-OSA，33.3%为NPD-OSA）。中位AHI从23.5次/小时降至4.8次/小时（P<0.0001），快速眼动（REM）和仰卧位AHI均降低。PD-OSA患者仰卧位AHI改善最大，而NPD-OSA患者非仰卧位AHI有独特改善。ESS总体中位数下降1.5分（P=0.0015），在NPD-OSA中达到最小临床重要差异。睡眠结构变化最小，除了仰卧位睡眠百分比降低（P=0.0114）。HNS治疗改善了OSA各表型的AHI和主观嗜睡程度，且有明显的体位反应。这些发现支持了HNS在PD-OSA和NPD-OSA中的临床应用，并表明特定表型的治疗效果值得进一步研究。
