Abstract
The prevalence of obstructive sleep apnea (OSA), its complex pathophysiology, and the suboptimal adherence rates with positive pressure therapy, necessitate alternative treatment strategies in many OSA patients. Hypoglossal nerve stimulation (HNS) represents a novel and unique therapeutic approach that combines a surgical implant procedure with a titratable medical device to provide multilevel upper airway improvement via neuromodulation of the hypoglossal nerve. A recent multicenter prospective trial reported significant reduction in polysomnographic measures of disease severity and significant improvement in patient-reported quality of life measures that were maintained at 3-year follow-up, with overall low morbidity and good patient acceptance and adherence. HNS therapy has established itself as a key component of the OSA treatment armamentarium, although further work is needed to advance the technology, determine the most appropriate patient phenotypes, refine the implant procedure, and optimize stimulation parameters and titration protocols.
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