0636 Development of a Prognostic Calculator for Treatment Response after Hypoglossal Nerve Stimulation

Abstract Introduction Hypoglossal nerve stimulation (HGNS) is an increasingly utilized alternative treatment option for obstructive sleep apnea in patients who are intolerant of positive airway pressure. Treatment response rates vary considerably after HGNS, with reported success rates around 66-72% among patients meeting Food and Drug Administration eligibility criteria. Improved understanding of the prognostic factors that contribute to treatment outcomes is needed to optimize patient selection. Our objective was to develop a prognostic calculator to support clinicians in identifying patients likely to achieve favorable treatment response to HGNS. Methods We analyzed a cohort of 528 patients who underwent HGNS at a single academic institution. The primary outcome was the change in the apnea-hypopnea index (AHI) between sleep studies performed preoperatively and postoperatively approximately 4 months after implantation. Linear regression was used to identify predictors of treatment response. Results The majority of patients were male (67.4%) with a mean age of 60.8 years, baseline body-mass index (BMI) of 28.5 kg/m2, and baseline AHI of 32.9 events/hour. The mean postoperative change in the AHI from baseline was -20.8 events/hour. Multivariable regression modeling that included gender, age, BMI, baseline AHI, and sleep endoscopy findings as scored by the Velum Oropharynx Tongue Epiglottis (VOTE) system was performed. The strongest predictors of postoperative change in AHI was the baseline AHI (B=0.26; 95% CI 0.17-0.34; p< 0.0001) and partial circumferential collapse of the velum (B=7.70; 95% CI 3.14-12.3; p=0.001). The regression model was then used to develop a web-based calculator that clinicians can use to estimate the predicted change in AHI with HGNS. Conclusion Understanding the prognostic factors that contribute to treatment response after HGNS can facilitate personalized care in OSA management. Future directions include validating the utility of this calculator as a clinical support tool and expanding its application to other treatment modalities and other outcomes beyond AHI. Support (if any)