Introduction: Nowadays, hypoglossal nerve stimulation (HNS) is an established treatment method for obstructive sleep apnea (OSA). Gaining weight over time can worsen the results. In the HNS therapy concept, in addition to optimization measures on the implant, weight reduction - as an escalation using bariatric surgery - should also be considered. However, it is unclear whether the different modes of weight loss have a different effect on therapy outcomes in the long term.

Method: From the Lübeck HNS cohort of currently over 235 patients, all patients who underwent bariatric surgery as part of HNS follow-up care or who underwent conservative weight loss with a reduction in body mass index (BMI) of at least 4 points were included. Daytime sleepiness was taken into account as ESS and apnea-hypopnea index (AHI).

Results: In total, 4 patients underwent bariatric surgery and 4 underwent conservative weight reduction. In the bariatric group there was an average BMI of 40.1 before surgical treatment and an average AHI of 58.98/h. One year after the operation, the average BMI had decreased to 30.8 and the AHI to 10.68. In the second year after therapy, the BMI fell further to 24.0, while the AHI increased to 26.43/h. In the conservative group there was an average BMI of 30.78 before weight loss and an average AHI of 17.75/h. A year later, the average BMI was 24.8. The AHI had fallen to 13/h. Two years after the reduction, there was also a BMI of 24.0 and an AHI of 25.73/h.

Conclusion: Both measures lead to a lasting improvement in obesity and OSA control under HNS therapy. In order to decide on a coordinated measure, a connection to the weight reduction programme is important. The involvement of the ENT specialist in long-term HNS follow-up care is crucial.

Armin Steffen ist Berater für Inspire Medical.