(1350) The Impact of Social Vulnerability on Hypoglossal Nerve Stimulation Use and Outcomes

Introduction: Social determinants of health influence surgical outcomes, yet their impact on hypoglossal nerve stimulation (HNS) treatment of obstructive sleep apnea (OSA) remains poorly characterized. We used the CDC Social Vulnerability Index (SVI), a neighborhood-level composite of socioeconomic and social risk, to evaluate associations between social vulnerability and HNS outcomes.

Methods: An institutional HNS database was queried for pre/post-HNS apnea-hypopnea index (AHI), early postoperative device adherence, pre/post-HNS Epworth sleepiness scale (ESS) and functional outcomes of sleep questionnaire (FOSQ-10), clinic loss to follow-up, postoperative complications, and revision/explant. Patient addresses were geocoded to census block groups, linked to SVI, and stratified into quartiles. Outcomes were compared across quartiles using one-way ANOVA and chi-square testing.

Results: 100 patients were included. Mean age ranged from 57.4-63.7 years and mean BMI 28.9-32.5 kg/m2 (Q1-Q4). The percentage of nights HNS was used differed across SVI quartiles (p=0.040), with lower use in the highest-vulnerability group (Q1 89% vs Q4 67%). Nightly hours of use (p=0.071) and the percentage of nights with ≥4 hrs use (p=0.066) showed similar trends but were not significant. AHI change (p=0.096), ESS change (p=0.099), FOSQ-10 change (p=0.469), and loss to follow-up (p=0.181) did not vary by SVI quartile. Postoperative complications, revisions, and explants were uncommon and not associated with SVI.

Conclusions: Higher social vulnerability was associated with lower HNS adherence, while objective and subjective measures of OSA severity and follow-up attrition were similar across quartiles. Adverse events were limited. SVI may help to identify patients who benefit from targeted adherence support after receiving HNS.