Affiliation:
1. Department of Otolaryngology–Head and Neck Surgery University of Cincinnati Cincinnati Ohio USA
2. Surgical Services Cincinnati Veterans Affairs Medical Center Cincinnati Ohio USA
3. Department of Otolaryngology–Head and Neck Surgery University of Miami Miami Florida USA
4. Department of Otorhinolaryngology University of Lubeck Lubeck Germany
5. Department of Otolaryngology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
6. Department of Otolaryngology–Head and Neck Surgery University of Texas‐Southwestern Medical Center Dallas Texas USA
7. Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
Abstract
AbstractObjectiveIn patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes.Study DesignObservational.SettingMulticenter registry.MethodsWe included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea‐Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction.ResultsNo relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Among all patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery.ConclusionIn ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.