(A1219) Racial Disparities in Hypoglossal Nerve Stimulation: A Cross-Sectional Survey Study

Introduction: While hypoglossal nerve stimulation (HNS) is becoming an increasingly used alternative therapy for obstructive sleep apnea (OSA) in patients who are intolerant to positive airway pressure (PAP), significantly more White patients have received HNS compared to non-White patients. Here, we evaluated awareness and perceptions of HNS for OSA in a racially diverse patient population.

Methods: Adult patients referred for sleep testing or seen in sleep surgery or medicine clinics were surveyed from April 2024 to December 2024. Survey was designed to assess prior awareness of and perceptions towards OSA therapies. Chart review was performed for additional demographic and clinical data. Continuous variables were compared using Mann-Whitney U tests. Categorical variables and differences between groups were compared using Chi-squared tests.

Results: Survey was completed by 59 patients (56% male, median age 50 yrs), of which 29 patients (49%) self-identified as non-White. No significant differences were observed for age, gender, education level, insurance status, or household income between groups. All respondents were diagnosed with OSA (59, 100%) with median 3% apnea-hypopnea index of 19/hr and 22/hr for White and non-White respondents, respectively (p=0.31). Lack of HNS awareness was common (32, 54%) and similar between groups (p=0.58). Among respondents aware of HNS, the most agreed-upon perceptions were concerns of complications (11, 42%) and scarring (9, 35%). Among respondents without HNS awareness, the most agreed-upon perceptions were concerns of complications (16, 50%) and fear of surgery (13, 41%). There were no racial differences in perceptions of fear of surgery (p=0.37), complications (p=0.90), scarring (p=0.16), cosmetic outcomes (p=0.63), and cost of surgery (p=0.99).

Conclusions: Most patients presenting to a tertiary sleep center did not have previous awareness of HNS, regardless of race. Efforts to improve the awareness of HNS and its safety could improve the equitable delivery of the full spectrum of OSA care.