Defining Adequate Hypoglossal Nerve Stimulation Titration Studies: Comparison of Titration and Postoperative Home Sleep Testing

Sunday, October 18, 2026

11:42 AM - 11:48 AM PT

Location: 403B

Presenting Author(s)

SL

Sophia Linguiti, BA

Medical Student
Thomas Jefferson University, United States

Co-Author(s)

YD

Yash S. Dixit, BS

Medical Student
Thomas Jefferson University
Philadelphia, Pennsylvania, United States
SH

Sarah Harrington, BA

Medical Student
Thomas Jefferson University - SKMC, United States
Andrew T. Neeson, BS

Medical Student
Thomas Jefferson University
Chadds Ford, PA, United States
Anika S. Walia, BA

Research Fellow/ Medical Student
Thomas Jefferson University
Boston, Massachusetts, United States
PK

Parvesh Kumar, BA

Medical Student
Thomas Jefferson University - SKMC, United States

Senior Author(s)

Colin T. Huntley, MD

Associate Professor and Vice Chair for Education
Thomas Jefferson University
Philadelphia, PA, United States

Introduction: Titration polysomnography (tPSG) is routinely used after hypoglossal nerve stimulation (HGNS) implantation, yet criteria for “adequate” titration and its ability to predict postoperative outcomes remain unclear. This study identifies tPSG parameters that best predict responder status to inform standardized titration protocols and postoperative outcome assessment.

Methods: HGNS patients (2016–2025) who completed a preoperative sleep study, tPSG, and postoperative HST were reviewed. tPSG were coded using three definitions of adequate TST and REM: (A) 30 minutes TST and greater than 20% REM, (B) 45 minutes TST and greater than 20% REM, and (C) 60 minutes TST and greater than 20% REM. Adjusted Pearson’s correlations and regressions evaluated associations between titration AHI metrics and postoperative HST AHI with responder status (AHI less than 15 and greater than 50% reduction).

Results: Among 125 patients (preoperative AHI=32.86 ± 16.13), 64.8%, 44.8%, and 30.4% of titration studies met Definitions A, B, and C, respectively. Postoperative AHI on HST correlated with multiple titration metrics, including full-night tPSG AHI (r=0.568, p< 0.001), therapeutic-amplitude AHI (r=0.493, p< 0.001), AHI-A (r=0.542, p< 0.001), AHI-B (r=0.494, p< 0.001), and AHI-C (r=0.452, p< 0.005). Full-night AHI best predicted postoperative AHI on HST (R^2=0.407) and responder status (AUC-ROC=0.735).

Conclusions: Full-night tPSG AHI best predicted postoperative AHI and responder status, while stricter TST/REM criteria demonstrated lower predictive validity. Limited time at therapeutic voltages and inadequate REM may underlie weaker performance of therapeutic AHI compared to full-night AHI. Ensuring sufficient duration and REM sleep at therapeutic settings could improve accuracy and clinical utility of HGNS titration.