(1341) Safety of Hypoglossal Nerve Stimulation in Patients with Pre-existing Implantable Devices

Introduction: Hypoglossal nerve stimulation (HNS) is an effective therapy for CPAP-intolerant obstructive sleep apnea patients, many of whom have pre-existing cardiac comorbidities, and thus, implantable medical devices. This study examines the incidence of adverse events and outlines perioperative and surgical considerations associated with HNS implantation in patients with existing implantable devices.

Methods: A retrospective review of 122 patients who underwent HNS implantation from January 2022– December 2024 by a single surgeon at a tertiary center was conducted. Patients were divided into two cohorts: those with pre-existing implantable devices, including cardiac implantable electronic devices, pain pumps, and nerve stimulators (n=17), and those without (n=105). Baseline characteristics, operative time, and one-year postoperative complications were compared using independent t-tests and Chi-square analysis.

Results: Baseline demographics, including age, BMI, and preoperative AHI, were comparable between groups. Operative time was shorter in patients with pre-existing implants (101.7 ± 23.0 vs. 116.8 ± 26.2 minutes; p=0.03). The overall complication rate was significantly higher in the implant group (35.3%) compared to the non-implant group (12.4%) (RR 2.85; 95% CI 1.25–6.47; p=0.016). Complications in the implant group included slurred speech, pneumonia, dysphagia, device extrusion, dysgeusia, thrombosis, transient ischemic attack (TIA), lower lip weakness, and epistaxis.

Conclusions: Patients with pre-existing implantable devices undergoing HNS implantation experienced a significantly higher postoperative complication rate, particularly thromboembolic and vascular events. Although baseline characteristics were similar, underlying cardiovascular comorbidities may contribute to increased risk. These findings emphasize the need for careful perioperative planning and multidisciplinary management.