Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: A systematic review and meta-analysis.
OBJECTIVE
Poor adherence to continuous positive airway pressure treatment in obstructive sleep apnea (OSA) adversely affects the effectiveness of this therapy. This study aimed to systematically review the evidence regarding the efficacy and safety of hypoglossal nerve stimulation as an alternative therapy in the treatment of OSA.


METHODS
Scopus, PubMed, and Cochrane Library databases were searched (updated through September 5, 2014).


METHODS
Studies were included that evaluated the efficacy of hypoglossal nerve stimulation to treat OSA in adults with outcomes for apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and effect on daytime sleepiness (Epworth Sleepiness Scale [ESS]). Tests for heterogeneity and subgroup analysis were performed.


RESULTS
Six prospective studies with 200 patients were included in this review. At 12 months, the pooled fixed effects analysis demonstrated statistically significant reductions in AHI, ODI, and ESS mean difference of -17.51 (95% CI: -20.69 to -14.34); -13.73 (95% CI: -16.87 to -10.58), and -4.42 (95% CI: -5.39 to -3.44), respectively. Similar significant reductions were observed at 3 and 6 months. Overall, the AHI was reduced between 50% and 57%, and the ODI was reduced between 48% and 52%. Despite using different hypoglossal nerve stimulators in each subgroup analysis, no significant heterogeneity was found in any of the comparisons, suggesting equivalent efficacy regardless of the system in use.


CONCLUSIONS
This review reveals that hypoglossal nerve stimulation therapy may be considered in selected patients with OSA who fail medical treatment. Further studies comparing hypoglossal nerve stimulation with conventional therapies are needed to definitively evaluate outcomes.


METHODS
NA
Department of Otorhinolaryngology , Hospital Lusíadas, Porto, Portugal; Center for Research in Health Technologies and Information Systems , University of Porto, Porto, Portugal.
Victor F
VF
Certal
Soroush
S
Zaghi
Muhammad
M
Riaz
Antonio S
AS
Vieira
Carlos T
CT
Pinheiro
Clete
C
Kushida
Robson
R
Capasso
Macario
M
Camacho
D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D007002:Hypoglossal Nerve / Q000502:physiology*; D058542:Implantable Neurostimulators; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*
Hypoglossal nerve stimulation; sleep apnea