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Sleep Medicine

Long-term Effect on BMI in OSA Patients Treated with HNS

Tuesday, October 3, 2023
9:39 AM - 9:45 AM East Coast USA Time
Location: 103A

    Presenting Author(s)

  • Daniel Ph Jira, Physician, Dr. med.

    Specialist for ENT, head and neck surgery
    Klinikum rechts der Isar, Technical University Munich, Munich
    Muenchen, Bayern, Germany

  • J. Ulrich Sommer, MD, PhD

    Professor and ENT, Head and Neck Surgeon
    Technical University of Munich
    München, Bayern, Germany

    • Co-Author(s)

  • Benedikt Hofauer, MD

    Resident
    Klinikum rechts der Isar, Technical University Munich
    Munich, Bayern, Germany

    • Senior Author(s)

  • Clemens Heiser, MD, PhD

    Professor and ENT, Head and Neck Surgeon
    Technical University of Munich
    Munich, Bayern, Germany

Disclosure(s):
Daniel Ph Jira, Physician, Dr. med.: No relevant relationships to disclose.
J. Ulrich Sommer, MD, PhD: No relevant relationships to disclose.
Clemens Heiser, MD, PhD: No relevant relationships to disclose.
Introduction: Obesity is one of the major risk factors for developing obstructive sleep apnea (OSA) and is associated with an increased severity of the disease. Since the last decade, hypoglossal nerve stimulation (HNS) is an established therapy for OSA-patients not tolerating CPAP therapy. Nevertheless, a high BMI as a surrogate parameter for obesity is associated with lower efficiency of HNS. Since body weight is generally increasing by age, the question arises if this is also the effect in patients treated with HNS.

Methods: 63 patients (53 male, 10 female) treated with unilateral hypoglossal nerve stimulation (Inspire Medical Systems, Golden Valley, USA) at the university hospital Klinikum rechts der Isar, Technical University Munich (Munich, Germany) were followed up 3 years and 6 years (n=10) after implantation. Demographic data including BMI was analyzed and compared to baseline parameters.

Results: In contrary to the statistically expected weight gain, median BMI decreased from 29.4 kg/m^2 at screening to 29.1 kg/m^2 at 3 years and 28.3 kg/m^2 at 6 years (p>0.05). The effect was particularly seen in female patients with a baseline BMI ≤ 32 kg/m^2, showing a significant median decrease from 29.7 kg/m^2 to 27.9 kg/m^2 after 3 years (p=0.04).
Patients with a baseline BMI > 32 kg/m^2 showed a trend for an increase in body weight, with an increasing median BMI of 33.4 kg/m^2 at baseline to 33.7 kg/m^2 after 3 years and 34.1 kg/m^2 after 6 years (p>0.05), respectively.

Conclusions: In this cohort, patients treated with HNS did not show the statistically expected weight gain after a 3 year and 6 year follow-up, but in contrary showing the trend for a mild weight loss. Female patients with a baseline BMI ≤ 32 kg/m^2 showed a significant weight loss.
This might be due to positive metabolic effects after effectively treating OSA or due to increased physical activity due to reduced daytime sleepiness.
Patients with a baseline BMI > 32 kg/m^2 on the other hand showed the statistically expected weight gain. Since higher BMI is associated with lower efficacy of HNS, these patients should be addressed with multimodal therapy to achieve long-term weight loss.