Outcomes of Hypoglossal Nerve Stimulation in Obstructive Sleep Apnea Patients with Prior Anterior Cervical Fusion

Monday, October 19, 2026

1:06 PM - 1:12 PM PT

Location: 403B

Presenting Author(s)

TA

Tyler J. Allcroft, BS

Medical Student
Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Co-Author(s)

Olivier O. Bourguillon, MD

Resident Physician
University of Pittsburgh Medical Center
PITTSBURGH, PA, Pennsylvania, United States
Praneet C. Kaki, BS

Medical Student
Sidney Kimmel Medical College Thomas Jefferson University
Philadelphia, PA, United States
Leonard E. Estephan, MD

Otolaryngology Resident
Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Senior 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

Disclosure(s):

Praneet C. Kaki, BS:

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

Introduction: Anterior cervical discectomy and fusion (ACDF) has been proposed to worsen obstructive sleep apnea (OSA) by reducing upper airway size, limiting cervical extension, and potentially injuring the pharyngeal plexus. We investigated whether a history of ACDF influenced outcomes in patients treated with hypoglossal nerve stimulation (HGNS).

Methods: We conducted a retrospective chart review of OSA patients treated with HGNS at two tertiary centers between 2015 and 2025. Patients with and without history of prior ACDF were identified for comparison. Inclusion required a pre-operative sleep study and a post-operative single-amplitude sleep study. A 2:1 propensity score match was performed to balance baseline characteristics including age, sex, body mass index, and pre-operative apnea-hypopnea index (AHI). Post-match analyses were conducted using Pearson’s chi-squared, Wilcoxon rank-sum, and Fisher’s exact tests, as appropriate.

Results: Post-match analysis of the ACDF cohort (n=31) versus non-ACDF cohort (n=62) demonstrated significantly higher final AHI (21.33 vs. 14.52, p=0.041), lower change in AHI (-13.40 vs. -23.39, p=0.019), lower rates of Sher15 success (37% vs. 60%, p=0.037), and lower rates of final AHI below 15 events/hour (40% vs. 63%, p=0.036). Patients in the ACDF cohort also had a significantly higher post-activation central apnea index (2.29 vs. 0.79, p=0.028) and higher rates of chronic opiate usage (30% vs. 5%, p=0.008).

Conclusions: Our data suggests that patients with OSA and prior ACDF may not respond as well to HGNS therapy as compared to non-ACDF patients. Future research should investigate the clinical significance of the differences in reported OSA outcomes for this population.