• World Neurosurg · Dec 2023

    Increased BMI correlates with less favorable postoperative outcomes after hypoglossal nerve stimulation for obstructive sleep apnea: A Retrospective Cohort Study.

    • Felix Corr, Fatma Kilinç, Jan Oros, Lina-Elisabeth Qasem, Ali Al-Hilou, Daniel Jussen, Marcus Czabanka, and Johanna Quick-Weller.
    • Department of Neurosurgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt, Germany. Electronic address: Felixcorresponding@gmail.com.
    • World Neurosurg. 2023 Dec 1; 180: e210e218e210-e218.

    ObjectiveObstructive sleep apnea is associated with high morbidity. Hypoglossal nerve stimulation (HNS) has become a novel (neuro-) surgical treatment strategy for obstructive sleep apnea, demonstrating good success rates. Beyond predefined inclusion and exclusion criteria, no precise data are available, enabling individual preoperative risk assessment. To improve preoperative risk stratification, this study analyzed individual patient factors that affect outcomes of HNS.MethodsFourteen patients treated with unilateral HNS were analyzed retrospectively. Assessed risk factors included: hypertension, diabetes mellitus, depression, smoking, alcohol consumption, body mass index (BMI), and disease duration. Treatment success was defined as a reduction in the postoperative apnea-hypopnea index (AHI) to ≤20 events/hour, with a relative reduction of at least 50% compared to baseline.ResultsA significant reduction in the postoperative apnea-hypopnea index was observed in all patients (P < 0.0001). BMI correlated significantly with postoperative AHI scores (95% confidence interval, 0.1519-0.8974; P = 0.018). Significant treatment success was observed in 50% of patients. Compared with the "Excellent Responder group," the "Responder group" demonstrated a significantly higher BMI (95% confidence interval, 1.174-6.226; P = 0.0078). Diabetes, hypertension, disease duration, smoking, depression, and alcohol consumption were not significantly associated with AHI reduction.ConclusionsOur findings suggest that BMI may be an independent risk factor for the response to HNS, with patients who had less benefit from therapy having significantly higher BMI than "Excellent Responders." Therefore, carefully selecting patients is crucial in obtaining optimal outcomes with HNS therapy, especially those with a high BMI.Copyright © 2023 Elsevier Inc. All rights reserved.

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