HYPOGLOSSAL NERVE STIMULATION IN THE TREATMENT OF OSA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: OBJECTIVES/HYPOTHESIS: Although Continuous Positive Airway Pressure (CPAP) is the first line therapy of Obstructive Sleep Apnea(OSA) long-term non-compliance highlights the need for alternative therapies. hypoglossal nerve stimulation (HNS) is an FDA approved treatment for patients with moderate-to-severe OSA who cannot adhere to CPAP therapy. This study is intended to systematically review the evidence regarding the efficacy and safety of HNS in the treatment of OSA. METHODS: Two independent reviewers examined clinical studies investigating HNS in the treatment of OSA in adults. Primary outcomes measured are apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and effect on daytime sleepiness (Epworth Sleepiness Scale [ESS]). Tests for heterogeneity and subgroup analysis were performed. RESULTS: At 12 months, the pooled fixed effects analysis demonstrated statistically significant reductions in AHI, ODI, and ESS with a mean difference of -20.03 [95% CI: -22.28, -17.77]; -14.97 [95% CI:-17.31, -12.64] and -5.02 [95% CI: -5.83, -4.20] respectively. At twelve months AHI, ODI and ESS improved from baseline 34.43+/-13.33 to 15.46 +/-14.76, 27.61+/- 14.13 to 13.47+/- 14.67 and 12.01+/-5.15 to 6.91+/- 4.34, respectively. Similarly, significant reductions in AHI, ODI, and ESS were observed at 6 months. Overall, the AHI reduced between 61% and 55%, and the ODI reduced by 55% and 51% at 6 and 12 months. Despite the use of different hypoglossal nerve stimulators, no significant heterogeneity was found in any of the comparisons, suggesting equivalent efficacy regardless of the system in use. CONCLUSIONS: Hypoglossal nerve stimulation therapy should be considered in selected patients with OSA who are unable to use CPAP. CLINICAL IMPLICATIONS: Emerging therapy for OSA in patients who are non-adherent to standard CPAP therapy. DISCLOSURES: no disclosure on file for muhammad arsalan; No relevant relationships by M Mador, source=Web Response no disclosure on file for amir shahbaz; no disclosure on file for saadia waheed; No relevant relationships by hafiz muhammad zubair, source=Web Response