Characterizing early response and adherence to hypoglossal nerve stimulation: real-world evidence from a single-center cohort.

PURPOSE: Real-world predictors of early response to hypoglossal nerve stimulation (HGNS) remain inadequately characterized. We aimed to examine baseline characteristics, oximetry patterns, and adjunctive therapies associated with treatment response in a routine clinical HGNS cohort. METHODS: We conducted a retrospective cohort study of adults receiving HGNS at a tertiary sleep center (2019–2025). Treatment response was defined as apnea-hypopnea index by 4% criteria (AHI4%) < 15 events/hour on first post-implant polysomnography. Baseline demographics, polysomnography characteristics including oximetry banding patterns, adjunctive medication exposure, and device adherence were compared between responders and non-responders using Wilcoxon rank-sum and Fisher exact tests. RESULTS: Among 56 implanted patients, 35 had post-implant polysomnography with complete AHI4% data. Twenty-eight (80%) were responders; median AHI4% decreased from 27.1 to 7.0 events/hour. Responders had lower body mass index (28.6 vs. 31.1 kg/m², p = 0.035) and baseline AHI4% (20.3 vs. 37.5 events/hour, p = 0.021). All non-responders demonstrated oximetry banding patterns compared to 77% of responders (p = 0.16). Response rates using AHI3% criteria were markedly lower (31% [11/36]). CONCLUSIONS: Lower BMI was associated with early HGNS response. Oximetry banding and adjunctive pharmacotherapy were common among non-responders, suggesting opportunities for combination therapeutic approaches. The substantial gap between AHI4% and AHI3% response rates highlights persistent arousal-based disturbances that may warrant additional intervention.