Hypoglossal Nerve Stimulator Implantation for OSA in Adults with Elevated BMI: Systematic Review and Meta-Analysis

Sunday, October 12, 2025

3:24 PM - 3:30 PM EDT

Location: 136

Disclosure(s):

Jasdeep Singh Kler, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicholas R. Lenze, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Allison K. Ikeda, MD, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael J. Brenner, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: To address the rising prevalence of individuals with obesity and OSA intolerant to CPAP, the Food and Drug Administration expanded body-mass index (BMI) eligibility criteria for hypoglossal nerve stimulator (HGNS) implantation from 32 kg/m2 to 40 kg/m2 in June 2023. However, few data are available on outcomes of HGNS implantation in this population.

Methods: We performed a systematic review of studies evaluating objective and subjective outcomes of HGNS implantation in adults with OSA with a BMI >32 kg/m2 vs. lower BMI, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The study was registered with PROSPERO and protocol is available online (CRD42024615769). The following databases were searched for relevant studies from database inception to 11/25/2024: Medline/PubMed, Embase, CINHAL, Scopus, Web of Science, and Cochrane Library. Per protocol, two reviewers independently screened abstracts, with subsequent full text review, data extraction, analysis, and risk of bias assessment.

Results: Of 3777 studies screened, 370 underwent full text-review, with preliminary analysis yielding 6 studies eligible for inclusion (n=837) and data extraction. Among studies that evaluated surgical success rate with Sher criteria (>50% reduction in apnea-hypopnea index (AHI) and post-operative AHI < 20 events/hr.), odds of success in patients with BMI > 32 kg/m2 were significantly lower compared to BMI ≤ 32 kg/m2 (4 of 5 studies). However, patients with BMI >32 kg/m2 still achieved significant reductions in AHI (often >50%) and Epworth Sleepiness Scale. Adverse events were rare and inconsistently reported, with no significant differences between groups.

Conclusions: Patients with BMI > 32 kg/m2 had lower odds of surgical success with HGNS based on Sher criteria compared to their counterparts with lower BMI. However, patients with higher BMI demonstrated measurable improvement in objective and subjective outcomes with acceptable safety. These data highlight need for further study including long term outcomes.

Presenting Author(s)

Jasdeep Singh Kler, MPH

Medical Student
University of Michigan Medical School
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Jasdeep Singh Kler, MPH

Medical Student
University of Michigan Medical School
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Nicholas R. Lenze, MD, MPH

Dr.
University of Michigan
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Dania K. Alazawi, BS

Medical Student
University of Michigan Medical School
Bloomfield Hills, MI, United States

Disclosure information not submitted.
Allison K. Ikeda, MD, MS

Fellow
University of Washington
Seattle, WA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
KV

Kathryn Vanderboll, MLIS

University of Michigan Library, United States

Disclosure information not submitted.
CG

Cathy Goldstein, MD

Clinical Professor
University of Michigan Sleep Medicine, United States

Disclosure information not submitted.
Paul T. Hoff, MD, MS

Associate Professor
University of Michigan - Department of Otolaryngology Head and Neck Surgery
Dexter, Michigan, United States

Disclosure information not submitted.
RD

Raj C. Dedhia, MD, MSCR

Associate Professor of Otorhinolaryngology & Medicine
University of Pennsylvania
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

Michael J. Brenner, MD

Associate Professor
U. of Michigan Medical School
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.