Long-Term impact of hypoglossal nerve stimulation on quality of life and mood in obstructive sleep apnea
Felix Corr (Frankfurt a. M.), Valentin Krüger (Frankfurt a. M.), Dilara Soydaş (Frankfurt a. M.), Fatma Kilinç (Frankfurt a. M.), Jan Oros (Frankfurt a. M.), Lina-Elisabeth Qasem (Frankfurt a. M.), Ali Al-Hilou (Frankfurt a. M.), Lena Stange (Frankfurt a. M.), Daniel Jussen (Frankfurt a. M.), Marcus Czabanka (Frankfurt a. M.), Johanna Quick-Weller (Frankfurt a. M.)
Obstructive sleep apnea is associated with significant morbidity and mortality. Poor sleep quality has a significant impact on the patient's quality of life and mental health. Hypoglossal nerve stimulation (HNS) represents a neurosurgical option for individuals who exhibit inadequate responses to standard treatment. Although the positive effects of nerve stimulation on objective measures such as the apnea-hypopnea index (AHI) have been observed, the long-term effects on quality of life and mood have not yet been investigated.
A single-center prospective analysis including twelve patients undergoing unilateral HNS (Inspire Medical Systems, Inc, Maple Grove, Minnesota) was performed between 2020 and 2024. All participants were assessed using the Becks Depression Inventory score (BDI-II) for mood evaluation, and the Quality-of-Life Scale questionnaire (QoL) at baseline, six months, and more than two years after stimulator activation. Patients were dichotomously stratified based on the degree of treatment success, defined as achieving a postoperative AHI of ≤ 20 events/h, with a reduction of at least 50% compared to baseline.
All participants completed the six-month follow-up, while three patients were lost to follow-up at over 2 years. The average follow-up time was 30.8 months. Five out of twelve patients were classified as non-responders. Mean BDS-II scores were 0.77, 0.49, and 0.42 (p < 0.05), and mean QoL scores were 4.93, 4.84, and 5.2 at the respective time points. Noteworthy differences in the QoL domain were seen in autonomy, family relationships, and close friends. In the BDS-II domain, significant improvements were noted in change in sleep habits, irritability, and suicidal thoughts, among others. Non-responders exhibited elevated BDI-II scores in 18/21, 20/21, and 17/21 categories, and demonstrated higher dissatisfaction rates in 13/16, 8/16, and 11/16 cases at the respective follow-up points.
Apart from measurable parameters such as AHI, there is a positive influence of HNS on the quality of life, particularly with more positive outcomes observed over a two-year period. As a subgroup, responders consistently exhibited higher satisfaction levels and lower BDI-II scores at all follow-up points. A slower or poorer response in satisfaction and mood should not be prematurely interpreted as treatment failure. Instead, the enhancement and restoration of quality of life seem to unfold gradually in the long-term trajectory.
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