1160 Examining Criteria in Hypoglossal Nerve Stimulation: A Case Insight

Abstract Introduction Introduced in 2001, the hypoglossal nerve stimulator (HGNS) is an implantable device designed to treat moderate to severe obstructive sleep apnea (OSA). FDA-approved on May 1, 2014, it offers an alternative for patients unable to benefit from continuous positive airway pressure (CPAP) therapy. However, not all patients may benefit, leading to the establishment of exclusion criteria based on factors such as body mass index, central and/or mixed apnea index >25%, complete concentric palatal collapse, patient age, and certain comorbidities such as neuromuscular and cardiac diseases. It is important to consider these criteria when screening patients to ensure the appropriate use of the device. Here, we present a case illustrating a patient who received a HGNS device according to established criteria but may not have been an ideal candidate.123 Report of case(s) A 55-year-old male with a history of hyperlipidemia, depression, and hypothyroidism status post (s/p) thyroidectomy to treat multinodular goiter, moderate OSA (AHI 16.2 events/hr) s/p uvulopalatopharyngoplasty and failed CPAP tolerance, underwent HGNS implantation. Post-procedure, an abnormal electrocardiogram led to a referral to cardiology, where he was found to have heart failure with a reduced ejection fraction of 20%. A follow-up titration polysomnography showed central events, presumed treatment emergent, following HGNS implantation. He is currently being monitored by cardiology for the optimization of his heart failure. Upon re-evaluation of his initial pre-implantation study, we felt that several of the hypopnea events may have been central hypopneas. Although his OSA is controlled with the HGNS, the patient still has central sleep apnea that is not being treated. Conclusion There is a lack of routine differentiation between central and obstructive hypopneas in current assessments, which poses a potential oversight in patient selection, impacting treatment planning. Central hypopneas should be included when assessing the 25% threshold of central events that would otherwise exclude a patient from receiving treatment. This case highlights the need for more stringent scoring criteria, specifically incorporating central hypopneas, to better screen high-risk patients and identify optimal candidates for hypoglossal nerve stimulation. Support (if any)