Relationship of Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation

Tuesday, October 3, 2023

9:15 AM - 9:21 AM East Coast USA Time

Location: 103A

Senior Author(s)

Reena Dhanda Patil, MD

Associate Professor
University of Cincinnati
Cincinnati, OH, United States

Co-Author(s)

Stacey L. Ishman, MD, MPH, FACS, FAAP, HCQM

Adjunct Clinical Professor - Otolaryngology Head & Neck Surgery - University of Cincinnati
Instructor, University of Wisconsin - Madison
Cincinnati, OH, United States
Ryan J. Soose, MD

Associate Professor
University of Pittsburgh
Pittsburgh, PA, United States
TC

Teresa Chan-Leveno, MD

Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Maria V. Suurna, MD

Professor
University of Miami
Miami, FL, United States

Presenting Author(s)

James S. Coxe, MD

Resident
University of Cincinnati
CINCINNATI, OH, United States

Co-Author(s)

Armin Steffen, MD

Attending
University of Lubeck
Luebeck, Schleswig-Holstein, Germany

Disclosure(s):

Stacey L. Ishman, MD, MPH, HCQM: No relevant relationships to disclose.

James S. Coxe, MD: No relevant relationships to disclose.

Introduction: It is unclear what impact comorbid insomnia has on sleep-related outcomes after hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea (OSA). We examined “nocturnal” question scores of the Insomnia Severity Index (ISI) to determine if baseline symptomatology was related to OSA severity reduction, device usage and changes in sleepiness and insomnia after implantation.

Methods: The Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) is an observational database that collects information before HGNS implantation through a final visit up to two years postoperatively. We included patients with a baseline ISI who enrolled after March 9, 2020 and completed the final visit by December 20, 2022. Independent variables included “nocturnal” questions of the ISI regarding “difficulty falling asleep” (DFA), “difficulty staying asleep” and “waking up too early”. Linear regression analysis was utilized to determine if these variables were related to the following outcomes: change in apnea hypopnea index (AHI)/Sher response rate from baseline to final visit, device usage at the final visit, and change in the Epworth Sleepiness Scale (ESS) and overall ISI score from baseline to final visit.

Results: No relationship was noted between any of the ISI “nocturnal” question scores and device usage, changes in AHI/Sher response rate or ESS scores. The change in overall ISI score from baseline to final visit was positively correlated with DFA (p < 0.05) - on average, for every one-point increase in the baseline DFA score, the improvement in ISI score increased by 1.29 points.

Conclusions: The presence of baseline nocturnal symptoms of insomnia was not related to HGNS efficacy, changes in sleepiness nor device usage at the final visit after HGNS implantation. However, patients with higher scores for the ISI question related to DFA at baseline had a greater degree of improvement in overall insomnia symptomatology at the final visit. HGNS may provide greater ease with sleep onset and subsequently increased sleep time, leading to overall improved symptoms related to insomnia at follow-up visits.