(1352) Trends in Hypoglossal Nerve Stimulation-Related Surgeries in Obstructive Sleep Apnea Patients

Introduction: Hypoglossal nerve stimulation (HGNS) is a surgical alternative for patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Trends in HGNS implants and HGNS-related surgeries in real-world cohorts are not yet well-described.

Methods: The TriNetX database was queried for adult patients who received CPAP with maximum body mass index (BMI) < 40 kg/m2, OSA diagnosis (entered at least twice), and at least one encounter between January 2015 (after U.S. approval of HGNS) and December 2025. HGNS-related Current Procedural Terminology codes were defined as new implantation (64568 or 64582), revision (64583), removal (64584), or pulse generator-related procedures including replacements (61885). Quarterly incidence (proportion of patients each fiscal quarter newly undergoing these procedures, expressed per 1000) was calculated from Q1 2015—Q3 2025.

Results: In total, 276,629 patients (64.7% male, 78.3% White) were included, with mean age 66.6±13.4 yrs and highest BMI 33.4±4.3 kg/m2. In the cohort, 1682 (0.6%) had undergone HGNS implant, 24 (0.009%) a revision, 36 (0.01%) an explant, and 395 (0.1%) a pulse generator-related procedure. The East South Central census division had the highest proportion with HGNS-related procedures (2.6%), while the Pacific division had the lowest (0.3%). Incidence of new implants increased from 2 (0.02) in Q1 2015 to 69 (0.45) in Q3 2025, peaking at 106 (0.56) in Q4 2024. Between 2015—2025, the incidence of revisions (0 to 4 per quarter, 0.00 to 0.02) and removals (0 to 7 per quarter, 0.00 to 0.05) stayed relatively consistent.

Conclusions: In an OSA population, the rate of HGNS implants increased, with low rates of removal/revision. Additional research is needed in the setting of evolving insurance coverage and novel device approvals.