Long-Term Generator Replacement Experience in Hypoglossal Nerve Stimulator Therapy Recipients With CPAP-Intolerant Obstructive Sleep Apnea

ObjectiveIn the last decade, hypoglossal nerve stimulation (HNS) has emerged as a therapeutic alternative for patients with obstructive sleep apnea. The original clinical trial cohorts are entering the phase of expected battery depletion (8-12 years). This study aimed to examine the surgical experience with implantable pulse generator (IPG) replacements and the associated long-term therapy outcomes. Study DesignRetrospective analysis of patients from the original clinical trial databases (STAR, German post-market) who were followed in the ongoing ADHERE registry. SettingInternational multicenter HNS registry. MethodsThe ADHERE registry and clinical trial databases were cross-referenced to identify the serial numbers of IPGs that were replaced. Data collection included demographics, apnea-hypopnea index (AHI), therapy use, operative times, and adverse events. ResultsFourteen patients underwent IPG replacement 8.3 +/- 1.1 years after their initial implantation. Body mass index was unchanged between the original implant and IPG replacement (29 +/- 4 vs 28 +/- 2 kg/m(2), p = .50). The mean IPG replacement operative time was shorter than the original implant (63 +/- 50 vs 154 +/- 58 minutes, p < .002); however, 2 patients required stimulation lead replacement which significantly increased operative time. For patients with available AHI and adherence data, the mean change in AHI from baseline to latest follow-up (8.7 +/- 1.1 years after de novo implant) was -50.06%, and the mean therapy use was 7.2 hours/night. ConclusionIPG replacement surgery was associated with low complications and shorter operative time. For patients with available outcomes data, adherence and efficacy remained stable after 9 years of follow-up.