Impact of Nasal Obstruction on Hypoglossal Nerve Stimulation Outcomes in Obstructive Sleep Apnea Patients

Introduction: Nasal obstruction is a common comorbidity in obstructive sleep apnea (OSA) patients and can also contribute to or exacerbate the condition. Hypoglossal nerve stimulation (HGNS) is a surgical treatment for OSA that works by activating tongue muscles to keep the airway open during sleep. This study evaluates the potential impact of nasal obstruction on HGNS outcomes and examines correlations among Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and Nasal Obstruction Symptom Evaluation (NOSE) scores.

Methods: A retrospective analysis was conducted on HGNS patients (CPT=64582) from 2019 to 2024 (n=214) at a single institution. Pre- and post-operative ESS, NOSE, and AHI scores were obtained from electronic medical records. Paired t-test and Pearson correlation analyses were performed in Python.

Results: NOSE scores were significantly decreased following HGNS therapy with a mean pre-HGNS score of 23.5 and mean post-HGNS score of 12.5 (n = 10, p = 0.034), suggesting meaningful improvement in nasal obstruction symptoms. Pre-operative AHI, NOSE, and ESS scores all demonstrated inverse correlations with changes in AHI, NOSE, and ESS, respectively (r = -0.63; r = -0.60; r = -0.80; p < 0.006), indicating that increased OSA severity, worse nasal obstruction symptoms, and higher sleepiness levels at baseline were associated with more substantial improvements following treatment. Pre-operative NOSE scores were not significantly correlated with AHI, ESS, or changes in AHI and ESS.

Conclusions: Greater baseline OSA severity, nasal obstruction, and sleepiness predicted increased treatment response. Though subjective nasal obstruction symptoms did not correlate with HGNS outcomes, they did improve following treatment. These findings demonstrate the potential of HGNS therapy to not only address OSA, but also improve symptoms of nasal obstruction, which may contribute to enhanced patient outcomes and quality of life.