Issue Navigator

Volume 15 No. 08
Earn CME
Accepted Papers

Scientific Investigations

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Clara H. Lee, BS1; Everett G. Seay, BS, RPSGT2,3; Benjamin K. Walters, MD4; Nicholas J. Scalzitti, MD4,5; Raj C. Dedhia, MD, MSCR2,3
1Emory University School of Medicine, Atlanta, Georgia;; 2Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia;; 3Emory Sleep Center, Emory Healthcare, Atlanta, Georgia;; 4Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, Texas;; 5Sleep Disorders Center, Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas

Study Objectives:

To determine whether therapeutic positive airway pressure (PAP) level predicts response to hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea using the coprimary outcomes of apnea-hypopnea index (AHI) and 4% oxygen desaturation index.


Combined cohort study from two US sleep otolaryngology training programs. Subjects were adults with AHI > 15 events/h who underwent HGNS. Eligible subjects had diagnostic preoperative sleep studies, full-night efficacy postoperative studies and therapeutic PAP levels available for analysis. Low and high PAP groups were compared using the t test for continuous variables and chi-square test for categorical variables.


Fifty-six patients met all inclusion criteria. On average, patients were male, Caucasian, middle-aged, and overweight. Thirteen patients were in the low PAP group (< 8 cm H2O) and 43 patients in the high PAP group (≥ 8 cm H2O). Although both groups experienced improvement of polysomnographic measures with HGNS, the low PAP group achieved a significantly larger mean AHI reduction (36.7 ± 22.7 versus 18.4 ± 23.4, P = .02). Additionally, the low PAP group had a greater response rate (defined as AHI < 20 events/h and > 50% reduction of AHI) than the high PAP group (92% versus 44%, P < .01).


Therapeutic PAP level may aid in the discernment of candidacy for HGNS, with a strong positive predictive value for PAP levels < 8 cm H2O. A larger prospective study is needed to confirm these findings.


Lee CH, Seay EG, Walters BK, Scalzitti NJ, Dedhia RC. Therapeutic positive airway pressure level predicts response to hypoglossal nerve stimulation for obstructive sleep apnea. J Clin Sleep Med. 2019;15(8):1165–1172.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $125/volume year for individuals or $225/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an article provides permission to access and print the article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.