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Video

Sleep Medicine

(A1207) Case of Hypoglossal Nerve Implant Stimulation Lead Malfunction: Methods for Identification and Management

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Pearl Doan

    Medical Student
    University of California, San Francisco
    San Francisco, California, United States

    • Co-Author(s)

  • Megan Durr, MD

    Associate Professor
    University of California, San Francisco
    San Francisco, California, United States

    • Senior Author(s)

  • JC

    Jolie L. Chang, MD

    Professor
    University of California, San Francisco
    San Francisco, California, United States

Disclosure(s):
Pearl Doan: No relevant relationships to disclose.
Megan Durr, MD: No relevant relationships to disclose.
Jolie L. Chang, MD: No relevant relationships to disclose.


Introduction: Hypoglossal nerve stimulation (HNS) is a procedure to treat patients with obstructive sleep apnea. We describe a case of stimulation lead malfunction. Understanding HNS lead malfunction, proper impedance testing, and how sleep apps can be used to monitor sleep can provide insight about how best to navigate HNS complications in the future.

Methods: A retrospective chart review from August 2020 to December 2024 of a patient with HNS implant was conducted. The patient received an INSPIRE (Inspire Medical) HNS implant. The patient used a consumer sleep app, SnoreLab (Reviva Softworks Ltd), which recorded the percentage of sleep in which she snored and snore severity. The patient’s SnoreLab results were analyzed retroactively after complaint of increased snoring and worsening sleepiness.

Results: The patient is a 65-year-old woman who underwent a successful INSPIRE hypoglossal nerve stimulation implant with 2 incision approach with no complications with a pre-operative AHI of 64 events per hour. The patient activated, uptitrated her implant, and completed regular check-ups with
no problems for 2 years after surgery. Post-implant therapeutic AHI was 11 events per hour at 1.2 Volts +-+ HNS implant setting. At 2 years, the patient reported worsened sleep quality and daytime sleepiness. She did not have a bedpartner and used the SnoreLab app which showed increased snoring percent compared to baseline. Impedance testing showed that the center stimulating electrode was not functional with abnormally high resistance. HNS settings were reconfigured to -0- electrode settings which utilizes the lateral electrodes for stimulation. She was uptitrated and had effective treatment on the new setting with improved snoring scores. The patient has since reported no issues with the implant and her post-reprogramming AHI was 5 events per hour.

Conclusions: Impedance testing can examine stimulation lead functionality when concerned about HNS malfunction. Certain consumer sleep tracking technologies can provide insight about changes in sleep apnea treatment effectiveness and alert to investigation of implant function.