Abstract
Abstract Introduction Hypoglossal nerve stimulation (HGNS) is an alternative therapy for patients with obstructive sleep apnea intolerant to positive airway pressure (PAP). Psychosocial variables proven to influence PAP adherence, such as race, ethnicity, and baseline insomnia, have not been well studied with HGNS. This study evaluates HGNS use based on ethnicity and baseline comorbid insomnia (COMISA). Methods We conducted a retrospective analysis of patients implanted with HGNS at the University of Miami and Miami VA sleep centers (2017-2023) who were seen for initial follow-up within one year post-implantation. Patient demographics, baseline sleep characteristics, comorbidities, and polysomnography variables were extracted from the electronic medical record. Comorbid insomnia was defined by sleep onset latency or wake after onset time > 30 mins. Comparisons between Hispanic and non-Hispanic patient characteristics were performed with Chi-square or Student t-tests, as appropriate. Objective HGNS adherence data and stimulation parameters were extracted from the Inspire cloud or tablet monitoring system at the most recent visit. Adjusted linear regression models were constructed to determine if COMISA and Hispanic ethnicity were associated with mean nightly HGNS use. Analyses were adjusted for age, gender, sleepiness, AHI, and time to follow-up. Results The cohort included 68 patients (18% female, 97% White, 53% Hispanic, 38% US Veterans) with mean age of 62 +/- 11 years, mean body mass index of 29 +/- 3 kg/m2, and baseline apnea hypopnea index of 37 +/- 19 events/hour. Mean duration since implantation was 35 +/- 30 months and mean HGNS use was 274 +/- 147 min/night. In unadjusted comparisons there were no differences in demographics, sleep characteristics, treatment parameters, time since implantation, or follow-up between Hispanics and non-Hispanics. In adjusted analyses, Hispanic ethnicity was associated with 81.7 (p=0.035) fewer minutes of nightly HGNS use compared to non-Hispanic individuals. COMISA was not significantly associated with HGNS adherence. Conclusion Ethnicity influences HGNS adherence, while COMISA does not significantly affect usage. Hispanic patients used HGNS more than one hour less per night compared to non-Hispanic individuals. Further evaluation of potential contributing factors, such as socioeconomic status and referral biases, is warranted. Support (if any)