Impact of Nasal Pathology on Efficacy of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

ABSTRACT Objectives Hypoglossal nerve stimulation (HNS) has emerged as a treatment for obstructive sleep apnea (OSA). While current literature suggests comorbid nasal pathology can decrease quality of life (QoL) in OSA populations, its impact on HNS efficacy has been less explored. This study assesses whether the presence of nasal pathology changes HNS efficacy in improving sleep outcomes in OSA patients. Methods A retrospective analysis evaluated 90 patients who underwent HNS implantation. Treatment efficacy and QoL were assessed preoperatively and postoperatively with apnea–hypopnea index (AHI), Epworth sleepiness scale (ESS), and functional outcomes of sleep questionnaire (FOSQ‐10). Nasal exam and nasopharyngoscopy findings derived four groups: normal nasal findings ( n = 44), positive anterior rhinoscopy findings ( n = 32), positive nasopharyngoscopy findings ( n = 36), and any positive nasal finding ( n = 46). Septal deviation, septal perforation, polyps, masses, vestibular stenosis, and turbinate hypertrophy were considered positive findings. Outcomes within and across groups were analyzed using t ‐tests, Mann–Whitney U ‐tests, and Wilcoxon signed‐rank tests. Results Both AHI and ESS scores significantly improved across all groups ( p < 0.05) following HNS. FOSQ‐10 in patients with positive anterior rhinoscopy findings did not significantly improve. Average FOSQ‐10 improvement was significantly greater in the control group compared to the positive anterior rhinoscopy findings ( p < 0.05). All groups met Sher15 and Sher20 criteria at similar rates. Conclusions Comorbid nasal pathology does not diminish the effectiveness of HNS in treating OSA, with all groups showing significant improvement in AHI and ESS scores. However, impacts on broader QoL, measured by FOSQ‐10, warrant further investigation. Level of Evidence 3.