0638 Evaluating Outcomes of a Sleep Medicine Screening Program for Hypoglossal Nerve Stimulation: A Single Center Retrospective Cohort Study

Abstract Introduction Positive airway pressure (PAP) remains the first-line treatment for moderate to severe obstructive sleep apnea (OSA). Due to high rates of PAP intolerance, Inspire’s hypoglossal nerve stimulation (HNS) system, is an FDA-approved alternative treatment option. At large academic centers, HNS programs are often led by sleep medicine-trained surgeons. As HNS treatment expands to hospitals without sleep-trained surgeons, alternative models are needed to evaluate patients interested in HNS. We developed a sleep medicine-led HNS program in which all patients expressing interest in HNS were evaluated by sleep medicine clinicians. Patients who met clinical criteria for HNS were referred for surgical evaluation. This single center retrospective cohort study reports outcomes for patients who were evaluated for HNS but did not undergo implantation. Methods Between 1/1/2023 to 6/30/2024, there were 288 patients who underwent sleep medicine consultation for HNS at LVHN; these charts were retrospectively reviewed. Results Out of 288 patients referred to sleep medicine for HNS, 9.4% underwent implantation with 89% of patients with use >4 hours per night. Among the patients who did not undergo surgery, the most common reasons were patient choice (41.4%), mild OSA or no OSA on sleep testing (23.7%), elevated BMI (16.1%), >25% central sleep apnea/mixed apneas (4.6%), and untreated insomnia (4.2%). Other reasons included supine-predominant OSA or significant medical co-morbidities prohibiting elective surgery. Among those who did not undergo implantation, 58.2% were counseled to pursue PAP therapy, 20.3% to pursue oral appliance, 19.2% to pursue positional therapy, and 3.4% were referred to bariatric medicine. Some treatments were concurrently recommended. Of those patients recommended to continue or restart PAP therapy, 53.3% had documented PAP/NIV adherence at follow-up. Interestingly, 7.7% of patients evaluated for HNS required no treatment for OSA as their sleep testing was negative. Conclusion Most patients do not meet clinical criteria for surgical implant or ultimately choose not to pursue it. Our sleep medicine-led HNS program demonstrates that evaluating all patients interested in HNS –even when they do not meet FDA guidelines for surgery—can effectively screen patients for surgical candidacy as well as successfully restart some patients on PAP therapy and offer alternative non-surgical solutions for sleep apnea. Support (if any)