Multicenter Retrospective Cohort Study of Explantation of Hypoglossal Nerve Stimulation System for Obstructive Sleep Apnea

Tuesday, October 20, 2026

7:48 AM - 7:54 AM PT

Location: 403B

Presenting Author(s)

JD

Julia Dmowska, MD

Fellow
UCLA Medical Center
Santa Monica, California, United States

Co-Author(s)

Colin T. Huntley, MD

Associate Professor and Vice Chair for Education
Thomas Jefferson University
Philadelphia, PA, United States
Thomas M. Kaffenberger, MD

Physician
University of Pittsburgh Department of Otolaryngology
Pittsburgh, Pennsylvania, United States
Maria V. Suurna, MD

Professor
University of Miami
Miami, Florida, United States

Senior Author(s)

Eric J. Kezirian, MD, MPH

Professor-in-Residence
UCLA
Los Angeles, CA, United States

Co-Author(s)

PH

Phillip A. Huyett, MD

Director of Sleep Surgery
Mass Eye and Ear
Boston, MA, United States
SB

Silvana Bellotto, MD

Research Fellow
VANDERBILT UNIVERSITY MEDICAL SCHOOL, United States

Disclosure(s):

Eric J. Kezirian, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Unilateral hypoglossal nerve stimulation (Upper Airway Stimulation, UAS) is an established treatment for obstructive sleep apnea that requires surgical implantation. As some proportion of patients require device explantation, this multicenter study evaluated experiences with UAS explantation.

Methods: A retrospective cohort study included >125 adults with OSA (AHI>15) who underwent UAS explantation in 8 centers. Data collected included study participant demographics, reason(s) for explantation, timing relative to implantation, operative findings, and techniques associated with explantation.

Results: The cohort was primarily white, male, and with severe OSA. The large majority of explanted systems involved Inspire IV (IPG Model 3128). Explantation occurred on average around 2 years post implantation (range from 1 month - 7 years). Key operative findings included thick scarring and the requirement of stimulation lead removal in multiple segments. In one instance the stimulation lead cuff was found on the proximal hypoglossal nerve. While the respiratory sensing lead was removed completely in all cases. The stimulation lead cuff was not removed in a few cases, although generally < 2 cm was left. Average operating time (incision to completion of closure) was approximately 2 hours. The most common primary reasons for explantation were pain or discomfort with tongue stimulation, nonresponse to therapy, and MRI incompatibility. Less-common reasons include allergic reaction, device migration, resolution of OSA, drooling, and pectoralis muscle atrophy.

Conclusions: Explantation of the Inspire therapy is routinely successful, with substantial operative time. Surgeons should anticipate dense scarring and the potential need for segmental lead removal. Because intolerance of stimulation is the most common reason for explantation, future research should explore whether preoperative patient selection or counseling may offer benefit.