Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry

Reena Dhanda Patil; Stacey L Ishman; Jolie L Chang; Erica Thaler; Maria V Suurna

doi:10.1002/lary.30933

Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry

Laryngoscope. 2024 Jan;134(1):471-479. doi: 10.1002/lary.30933. Epub 2023 Aug 10.

Authors

Reena Dhanda Patil^{1

2}, Stacey L Ishman³, Jolie L Chang^{4

5}, Erica Thaler⁶, Maria V Suurna⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
² Surgical Services, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA.
³ Department of Community and Population Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴ Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
⁵ Surgical Services, San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA.

PMID: 37560883
DOI: 10.1002/lary.30933

Abstract

Objective: We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep-related data longitudinally, in particular the Insomnia Severity Index (ISI), to compare outcomes between patients with no/subthreshold insomnia (ISI < 15) and moderate/severe insomnia (ISI ≥ 15) at baseline.

Methods: We analyzed observational data from ADHERE between March 2020 and September 2022. Baseline demographic and mental health (MH) data, apnea hypopnea index (AHI), ISI, and ESS (Epworth Sleepiness Scale) were recorded. At post-titration (PT) and final visits, AHI, ISI, ESS and nightly usage were compared between baseline ISI < 15 and ISI ≥ 15 subgroups.

Results: A baseline ISI was obtained in 928 patients (62% with ISI ≥ 15). Of the 578 and 141 patients reaching the 12- and 24-month time periods to complete PT and final visits, 292 (50.5%) and 91 (64.5%) completed the ISI, respectively. Baseline MH conditions were higher with ISI ≥ 15 than ISI < 15 (p < 0.001). AHI reduction and adherence did not differ between patients with baseline ISI ≥ 15 and ISI < 15. Patients with ISI ≥ 15 experienced greater improvement in ESS than ISI < 15 at post-titration and final visits (p = 0.014, 0.025). All patients had improved nocturnal, daytime, and overall ISI scores at follow-up visits (p < 0.001), especially for those with baseline ISI ≥ 15 compared with ISI < 15 (p < 0.05).

Conclusion: HGNS therapy efficacy and adherence were similar between ISI severity subgroups at follow-up visits. Insomnia and sleepiness scores improved in all patients with HGNS therapy and to a greater degree in patients with baseline moderate/severe insomnia.

Level of evidence: 4 Laryngoscope, 134:471-479, 2024.

Keywords: hypoglossal nerve stimulation; insomnia; obstructive sleep apnea; sleep surgery; upper airway stimulation.

© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Publication types

Comparative Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Electric Stimulation Therapy*
Humans
Hypoglossal Nerve
Registries
Sleep Apnea, Obstructive* / surgery
Sleep Initiation and Maintenance Disorders* / epidemiology
Sleep Initiation and Maintenance Disorders* / etiology
Sleep Initiation and Maintenance Disorders* / therapy
Sleepiness
Treatment Outcome

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