Document resource
Introduction Obstructive sleep apnoea (OSA) is a highly prevalent condition. First-line treatments include continuous positive airway pressure (CPAP) therapy and mandibular advancement devices (MAD). However, long-term adherence to CPAP therapy may be limited and access to a MAD via an NHS dentist often proves challenging. Hypoglossal nerve stimulation (HNS) is an emerging non-CPAP therapy using an implant to activate the upper airway dilator muscles and maintain upper airway patency in the asleep OSA patient. We audited the data from the first UK hospital providing HNS.Methods Data was audited using the NICE audit tool (IPG598). Our hospital is a tertiary referral centre for sleep disorders, and since 2020 we have established a multidisciplinary meeting to discuss difficult-to-treat cases of OSA, and non-CPAP therapeutic options. We report on the clinical outcomes and resources used to treat the first HNS patients in the NHS. Eligibility criteria were failed PAP, apnoea hypopnoea index (AHI) 15-65/hour, BMI <35kg/m2, central apnoeas <25%.Results Between 02/2022 and 02/2025 we implanted HNS in 13 patients with OSA (age 51.6 (10.0) years, 12 male, BMI 28.5 (2.6) kg/m2). Average follow-up post-implantation was 22.8 (10.9) months. Following activation and titration of the electrical current, respiratory indices (AHI pre 48.0 (16.5) vs post 15.9 (11.9) hour-1, p<0.001) and symptoms (Epworth Sleepiness Scale, ESS pre 12.4 (5.6) vs post 9.5 (5.9) points, p=0.017) improved. Patients used the treatment on average 5.9 (2.0) hours x night-1. Peri-procedural contacts included ENT (n, 7.5 (4.2)) and Sleep Centre interactions (n, 2.3 (1.7)), and 1.9 (1.0) sleep studies x case-1. No severe adverse events were reported.Discussion HNS can be safely delivered to improve clinical outcomes of patients with OSA who have failed first-line treatments. The approach requires clear eligibility criteria, but remains resource-intense and is dependent on regular multidisciplinary input.