Impact of Bariatric Surgery on Hypoglossal Nerve Stimulation Outcomes

ABSTRACT Objective The effectiveness of hypoglossal nerve stimulation (HGNS) for residual obstructive sleep apnea (OSA) in patients with prior bariatric surgery (BS) has not been previously reported. We evaluate and compare HGNS outcomes in this unique population. Methods We conducted a multi‐institutional retrospective review between 2014 and 2023. Patients with prior BS were compared to those without (nBS). A 1:2 propensity score matching (PSM) was performed using age, gender, race, and baseline BMI. Data collected included demographics, pre/post‐operative apnea‐hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Score (ESS). Treatment success was defined using Sher15 criteria. Analyses were conducted in R‐Studio. Results After PSM, 72 patients met inclusion (mean age 61.3 years, 62% male, 83% White), including 24 (33%) with BS. Sher15 response rates were 71% in BS vs. 56% in nBS ( p = 0.2). BS patients had significantly greater mean AHI reductions than NBS (−28.44 ± 16.39 vs. −17.68 ± 21.23; p = 0.009). Both groups had comparable reductions in ESS (−4.67 vs. −3.44; p = 0.2), with a mean postoperative ESS of 6.78 in BS and 6.17 in NBS ( p = 0.5). On multivariable linear regression adjusting for demographics, baseline AHI, and BMI, prior BS was independently associated with greater AHI reduction (β = −8.6; 95% CI −16, −1.1; p = 0.026). Conclusion Patients with prior BS achieve comparable or superior outcomes following HGNS. Prior weight loss may enhance HGNS effectiveness and merits further study. Level of Evidence 3.