Correlation Between Cephalometric Values and Sleep Outcomes Following Hypoglossal Nerve Stimulation: A Prospective Study

Monday, October 19, 2026

1:18 PM - 1:24 PM PT

Location: 403B

Presenting Author(s)

Soomin Myoung, MD

Resident
Duke University Department of Otolaryngology
Durham, NC, United States

Co-Author(s)

JG

Jennifer Grauberger, MD

Plastic Surgery Resident
UMass Chan Medical School/Umass Memorial Medical Center, United States
KB

Kendyl Barron, MD

Resident
UMass Chan Medical School/Umass Memorial Medical Center, United States
MM

Michael Murphy, MD

Assistant Professor
UMass Chan Medical School/Umass Memorial Medical Center, United States
RA

Ricardo Aulet, MD

Assistant Professor
UMass Chan Medical School/UMass Memorial Medical Center, United States

Senior Author(s)

JL

Jonathan Lee, MD, MPH

Associate Professor
UMass Chan Medical School - Baystate, United States
CI

Christopher J. Ito, MD, MEd

Associate Professor; Director, Rhinology & Endoscopic Skull Base Surgery
UMass Memorial Medical Center / UMass Chan Medical School
Worcester, MA, United States

Disclosure(s):

Soomin Myoung, MD:

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

Kendyl Barron, MD:

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

Christopher J. Ito, MD, MEd:

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

Introduction: Hypoglossal nerve stimulation (HNS) is an effective long-term surgical treatment option for patients with obstructive sleep apnea; however, more than one-third of patients experience suboptimal benefits. This study aimed to evaluate whether certain cephalometric variables are associated with improved subjective and objective surgical outcomes following HNS.

Methods: A prospective cohort study was conducted from January 2024 to November 2025 of patients who underwent HNS implantation at a single tertiary care center. Skeletal cephalometric measurements were obtained from protocolized lateral neck radiographs. Objective sleep parameters (apnea–hypopnea index (AHI)) and subjective sleep quality measures (Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ)) were obtained pre- and postoperatively. Clinical cut-off values for significant variables were determined using the Youden Index (YI) from receiver operating characteristic analyses. Surgical response was defined as a postoperative AHI < 20 with a ≥ 50% reduction from baseline. Univariate analyses were performed using the Wilcoxon Signed-Rank Test and Spearman’s rho.

Results: A total of 96 patients (70.8% male; median age 64.2 years; median BMI 29.2) were included. Post-titration sleep studies showed a median reduction in AHI from 28.8 to 15.5 (p = 0.01). Significant improvements were also seen in mean oxygenation (93.0% to 93.4%; p = 0.04), ESS (9 to 6; p = 0.04), and FOSQ scores (15.7 to 18.3; p = 0.003). Cephalometric features associated with reduced improvement included a retrognathic mandible (YI: 81.3°; p = 0.01), increased mandible–hyoid distance (YI: 25.95 cm; p = 0.01), decreased pharyngeal depth (YI: 25.75 cm; p = 0.04), and a greater Needs ratio (soft palate depth to length ratio (YI: 0.64; p = 0.003)).

Conclusions: Patients with retrusive mandibular features were less likely to benefit from HNS, underscoring incorporation of cephalometric assessment into the initial surgical evaluation to guide appropriate treatment selection, including consideration of orthognathic alternatives.