(1347) Survey-Based Assessment of Therapy Use Among Patients Lost to Follow-Up After Hypoglossal Nerve Stimulation

Introduction: Hypoglossal nerve stimulation (HGNS) demonstrates high efficacy for obstructive sleep apnea (OSA), yet clinicians lack longitudinal outcome assessments in patients without ongoing follow-up. We assessed current HGNS use, patient-reported outcomes, and alternative OSA management among patients lost to follow-up (LTFU).

Methods: We reviewed adults who underwent HGNS implantation at a single academic center (2014-2024). LTFU was defined as >528 days since the last visit. Deceased patients (n=14) and explanted HGNS devices (n=16) were excluded. Stratified random sampling by implantation year was used for telephone outreach. A standardized survey assessed current HGNS use, self-reported adherence, satisfaction, alternative therapies, and reasons for discontinuation or lack of follow-up.

Results: Among 608 patients, 288 (47%) met criteria for LTFU. LTFU patients were significantly more likely to be male (71% vs 62%; p=0.013). Additionally, patients who lived farther from the clinic were significantly more likely to be LTFU (p=0.024). Insurance type, race, primary language, ADI, BMI, and comorbidity burden did not differ significantly between groups.

Conclusions: Male sex and greater distance from health centers may identify patients who are at an increased risk of being lost to follow-up. The absence of traditional SES barriers observed in CPAP-treated OSA may reflect the insurance and access requirements inherent to HGNS candidacy, suggesting SES selection may occur prior to implantation rather during follow-up. These results highlight the need for future multicenter studies to direct patient outreach resources both before and after implantation.