Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: Update on French practices and position paper of the SFRMS, SPLF and SFORL sleep medicine work-group.

OBJECTIVES

To update practices for setting up, follow-up and indications in hypoglossal nerve stimulation in France.

METHODS

Analysis of Medline, Cochrane and Embase databases (1970-2024), with assessment of techniques, follow-up modalities, results and side effects. Six physicians (3 ENT specialists, 3 pulmonologists, all involved in hypoglossal stimulation) took part in a work-group between January 2024 and January 2025.

RESULTS

Only one implant, Inspire IV, is available in France, indicated for non-obese (BMI<32kg/m2) patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome (OSAHS) (apnea/hypopnea index [AHI] 15-50/h), and failure of or contraindications for continuous positive airway pressure (CPAP) or mandibular advancement device (MAD). Prior drug-induced sleep endoscopy (DISE) is mandatory. Studies show a 68% decrease in AHI, 70% decrease in oxygen desaturation index (ODI) at 12months, and improvements in somnolence and quality of life, which seem stable at 36months. About 25% of patients experience side effects, which are mostly transient. Final set-up requires polysomnography; follow-up requires clinical examination and/or poly(somno)graphy.

CONCLUSION

This new alternative treatment in France should be proposed for symptomatic patients with failure of CPAP or MAD, rigorously screened in multidisciplinary centers.