1204 Acceptability and Feasibility of Integrating Behavioral Sleep Medicine into HGNS Program

Abstract Introduction Obstructive sleep apnea (OSA) is common and contributes to substantial medical and societal burden. Continuous positive airway pressure is the standard treatment, yet adherence is often reduced by equipment discomfort, medical conditions, and psychological symptoms. Hypoglossal nerve stimulation (HGNS) offers an alternative for individuals who do not tolerate continuous positive airway pressure. Behavioral and psychosocial factors also influence HGNS use, suggesting a role for integrated care. Real-world data describing patients referred to interdisciplinary HGNS programs remain limited. This study describes the development of an interdisciplinary HGNS service line and presents baseline characteristics for all referrals during its first two years. Methods The service line was implemented at an academic medical center and included otolaryngology, sleep medicine, and behavioral sleep medicine (BSM). Otolaryngology completed intake visits and administered screening measures. Patients were referred to BSM when scores exceeded clinical thresholds on the Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7, or Patient Health Questionnaire-9. BSM evaluations assessed insomnia, psychiatric symptoms, medication use, sleep behaviors, and treatment needs. Clinical and demographic data were extracted from electronic records for all patients referred 2021-2023. Results Forty-eight patients were referred, 39.6% pre-implant and 60.4% post-implant. Patients were mostly male (62.5%) and White (95.8%), with a mean age of 58.5 years. Insomnia was common, with 85.4% receiving a clinical diagnosis and showing moderate ISI scores. Depression was identified in 50% of patients and anxiety in 18.8%. Cognitive behavioral therapy for insomnia was recommended in 87.5% of cases, and the majority of patients (68.8%) attended at least one follow-up. For those who attended any follow-up sessions, mean attendance was higher for those referred post-implantation (M = 4.7, SD = 2.3) than those referred pre-implantation (M = 3.1, SD = 2.5), a difference that approached significance (p = 0.09). HGNS use was similar between groups, with the sample averaging use on 82.5% of nights for 5.8 nightly hours. Patients referred after implantation exhibited more nightly pauses than those referred before implantation (p = .09). Conclusion Findings demonstrate high insomnia prevalence, frequent psychiatric symptoms, and strong engagement with behavioral treatment when delivered within an interdisciplinary HGNS service. Support (if any) None